A SAME-DAY DIRECT-ACCESS CHEST PAIN CLINIC - IMPROVED MANAGEMENT AND REDUCED HOSPITALIZATION

The aims of the Chest Pain Clinic were: to establish rapid-access, 'sa me-day', referral and attendance without a waiting list; to provide a diagnosis, treatment and follow-up plan for each patient; and to optim ize the use of hospitalization for appropriate patients. Prospective d ata were collected from 1001 consecutive General Practitioner referral s to the Chest Pain Clinic over a 22-month period. Hospital admissions were reduced from an estimated 268 to 145 patients. Without a Chest P ain Clinic service, 213 (21%) would have been admitted inappropriately , and 89 (9%) with unstable angina or myocardial infarction would pote ntially have been managed in the community. A firm diagnosis was provi ded in 92% of cases (919 patients) with 42% (418) diagnosed as having ischaemic heart disease. The provision of a Chest Pain Clinic reduces the hospitalization of patients with benign non-cardiac chest pain whi lst facilitating the identification of those patients with acute coron ary syndromes requiring in-patient care. The Chest Pain Clinic service has a higher diagnostic yield for ischaemic heart disease than open a ccess exercise electrocardiography, provides the General Practitioner with a firm clinical diagnosis in over 90% of cases, and identifies th ose patients requiring further treatment and invasive investigation.