AUDIT OF PATIENTS WITH CHEST PAIN PRESENTING TO AN ACCIDENT AND EMERGENCY DEPARTMENT OVER A 6-MONTH PERIOD

The results of a 6-month retrospective audit of patients presenting wi th chest pain to an accident and emergency (A&E) department to which 4 6 000 new patients per year present are discussed. The computer diagno stic code assigned to the patients by the A&E doctor, referral rates f or second opinion and disposal after assessment in the A&E department are examined, with particular reference to patients who may have had s erious cardiac pathology, such as acute myocardial infarction (AMI) or unstable angina. Audit showed that overall 61% of patients with chest pain of all causes were assessed and discharged home by A&E doctors w ithout recourse to second opinion. Of patients thought by the A&E doct ors to have chest pain of cardiac origin, who were referred to the dut y medical registrar or cardiologist, 88% were admitted. As a result of these findings a policy of more open referral for second opinion was instituted to reduce the likelihood of discharging patients home with serious cardiac pathology. In addition, the clinical problems of AMI a nd unstable angina are emphasized to all senior house officers early i n their educational programme after joining A&E. Published literature on the diagnosis and misdiagnosis of AMI and unstable angina in the A& E department is reviewed. These studies are almost exclusively from No rth America, and a need for similar work in the U.K. is discussed.