IMPACT ON THE CARE OF THE EMERGENCY DEPARTMENT CHEST PAIN PATIENT FROM THE CHEST PAIN EVALUATION REGISTRY (CHEPER) STUDY

This study examines the question of whether chest pain observation uni ts increase the proportion of chest pain patients with an extended eva luation for cardiac ischemia (''rule out myocardial infarction [MI] ev aluation''), decrease the number of missed MIs, and decrease costs. Th is is a multiple site registry study of 8 established chest pain obser vation units (complying with the American College Emergency Physician' s Observation Section's standards) compared with previous studies on c hest pain evaluation without the use of observation (5 studies, 12,405 patients). A total of 23,407 of 444,189 emergency department patients (5.3%) had the chief complaint of chest pain during the study period. In the chest pain observation units, 153 of 2,229 patients (6.9%) wit h acute MI were identified. Most of the observation chest pain patient s (76%) were discharged home without hospital admission. Compared to p revious studies, a higher proportion of patients underwent a ''rule ou t MI evaluation'' (67%, 95% confidence interval [CI] 66%, 68% vs 57%, 95% CI 56%, 58%; p < 0.001) equal to 2,250 additional patients complet ely evaluated ($1,219,500 additional costs). A lower proportion of Mis were missed (0.4%, 95% CI 0.3%, 0.5% vs 4.5%, 95% CI 4.0% to 5.5%; p < 0.001) as estimated by return visits within 72 hours. Compared to pr evious studies, final hospital admission rate was lower (47%, 95% CI 4 6%, 48% vs 57%, 95% CI 56%, 58%; p < 0.001); equal to 2,314 hospital a dmissions avoided in the study population ($4,093,466 saved costs). Ca lculated true costs overall were lower by $2,873,966 at the study hosp itals. Thus, chest pain observation units increased the proportion of pain patients thoroughly evaluated with improved quality af care and l ower costs. (C) 1997 by Excerpta Medica, Inc.