Weekend and holiday exercise testing in patients with chest pain

OBJECTIVE: To determine the outcome, safety, and possible cost savings of p atients undergoing weekend or holiday exercise treadmill testing. DESIGN: Medical records of all 195 patients scheduled for weekend and holid ay exercise testing were reviewed, and 77.9% of patients were contacted by telephone to ascertain medical outcomes and need for further emergency depa rtment or inpatient care. Casts were calculated from estimates of days of h ospitalization saved and incremental costs incurred in conjunction with wee kend or holiday testing. SETTING:Urban tertiary care academic medical center. PATIENTS: a total of 195 patients were scheduled for testing, and 181 tests were performed. Over three quarters (75.1%) of patients underwent testing for assessment of chest pain. Other indications included risk stratificatio n after myocardial infarction or coronary angioplasty or prior to noncardia c surgery, or evaluation for arrhythmias, dyspnea, or syncope. MEASUREMENTS AND MAIN RESULTS: Outcomes included results and complications of testing, hospital course after testing, subsequent emergency department visits and readmissions, myocardial infarction, need for cardiac catheteriz ation or revascularization, and mortality. No complications were noted duri ng testing. In 136 patients tested for the indication of chest pain, 90 (66 .2%) had negative tests, 39 (28.7%) were intermediate, and 6 (4.4%) were po sitive for ischemia. Same day discharge occurred in 115 (84.6%) of the pati ents, saving an estimated 185 days of hospitalization ($316.83 per patient tested). Event rates over the 6 months following discharge were low. CONCLUSIONS: Weekend and holiday exercise testing Is a safe and effective m eans of risk stratification prior to hospital discharge for patients with c hest pain. It also reduces length of stay and is cost saving.