Background: Chest pain units (CPUs) provide a system of care for patients with acute chest pain that can improve outcomes while reducing health service costs. The Effectiveness and Safety of Chest Pain Assessment to Prevent Emergency Admissions (ESCAPE) multicentre trial was undertaken to determine whether CPUs could be successfully established throughout the National Health Service (NHS).
Aim: To describe the structure, processes and outcomes of patients managed by CPUs in the ESCAPE Trial.
Method: 7 of 14 participating hospitals were randomly allocated to establish CPU care. Each hospital set up a CPU using standardised protocols to provide biochemical cardiac marker and exercise treadmill testing for low-risk patients. Research staff then followed up patients for 30 days to identify any adverse events, defined as chest pain-related readmission to hospital for more than 48 h, non-fatal myocardial infarction and all deaths.
Results: The 7 units managed a total of 1644 patients during their first year of operation. Activity varied from 1 to 7 patients per 1000 adult emergency department attendances. Overall, 1374 (83%) patients were discharged after CPU assessment, with 23 (1.7%) adverse events recorded among those discharged. Some, but not all, of the variation in activity could be attributed to hospital size and patient selection.
Conclusion: CPU care can be instituted in a safe manner at a variety of NHS hospitals, with most patients being discharged after assessment. However, there is variation in the number and type of patients managed by the different units. Further research is required to identify reasons for variation in CPU activity.
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Funding: The ESCAPE trial was funded by the NHS Service Delivery and Organisation R&D Programme.
Competing interests: None declared.
Contributors: Project Management Group: Jane Arnold, Research Fellow, University of Sheffield (Clinical Manager); Simon Capewell, Professor of Clinical Epidemiology, University of Liverpool (North-West Lead); Liz Cross, Research Associate, University of Sheffield (Research Manager); Steve Goodacre, Professor of Emergency Medicine, University of Sheffield (Principal Investigator); Maxine Johnson, Research Associate, University of Sheffield (Qualitative Researcher); Cath Lewis, Research Associate, University of Liverpool (North-West Co-ordinator); Francis Morris, Consultant in Emergency Medicine, Northern General Hospital, Sheffield (Chest Pain Unit Advisor); Jon Nicholl, Director MCRU Policy Research Programme, University of Sheffield (Statistician), Yemi Oluboyede, Research Associate, University of Sheffield (Health Economist); Susan Read, Honorary Research Fellow, University of Sheffield (Nursing Advisor); Angela Tod, Principal Research Fellow, Centre for Health and Social Care Research, Sheffield Hallam University (Qualitative Advisor).
Trial Steering Committee: Phil Adams, Consultant Cardiologist, Newcastle upon Tyne NHS Foundation Trust (Co-applicant); Tim Coats, Professor of Emergency Medicine, University of Leicester; Nicky Cullum, Professor, Centre for Evidence Based Nursing, University of York (Independent Chair); Alasdair Gray, Consultant in Emergency Medicine, Edinburgh Royal Infirmary (Co-applicant); Enid Hirst (Lay member); Jason Kendall, Consultant in Emergency Medicine, Frenchay Hospital, Bristol (Independent member); David Newby, Professor of Cardiology, The University of Edinburgh (Co-applicant); Simon Dixon, Senior Lecturer, University of Sheffield (Health Economist).
Data Monitoring Committee: Jonathan Benger, Consultant in Emergency Medicine, Bristol Royal Infirmary; David Gray, Reader in Medicine and Honorary Consultant Physician, Epidemiology and Health Services Research Unit, Queen’s Medical Centre, Nottingham; Robin Prescott, Statistical Advisor, Medical Statistics Unit, Public Health Sciences, The University of Edinburgh.
Principal Trial Staff: University Hospital Aintree: John Hollingsworth (ED Lead), Erwin Rodrigues (Cardiology Lead), Paula McCarten (Cardiac Specialist Nurse); Whiston Hospital: David Roe (ED Lead), Dave Johns (Chest Pain Nurse); Halton General Hospital: Dr Serge Osula (Cardiology Lead), Karen Randles (Cardiac Nurse Specialist); Wythenshawe Hospital: Darren Walter (ED Lead); Warrington Hospital: Steve Crowder (ED Lead), Cindy Lancaster (ED Nurse); West Cumberland Hospital: Charles Brett (ED Lead), Guy Bickerton (ED Lead); Peterborough District Hospital: Rob Russell (ED Lead); Dewsbury and District Hospital: Dean Okereke (ED Lead); Scunthorpe General Hospital: Ajay Chawla (ED Lead), Julia Lindley (Administration/Systems Manager), Julie Housham (Chest Pain Nurse), Sarah McGugan (Chest Pain Nurse); Queen’s Medical Centre Nottingham: Frank Coffey (ED Lead), Phil Miller (Emergency Department Research Coordinator); Taunton and Somerset Hospital: Cliff Mann (ED Lead), Andria Haffenden (Chest Pain Nurse), Bridget Capewell (Chest Pain Nurse); Hairmyres Hospital: John Keaney (ED Lead); City Hospital Birmingham: Nigel Langford (MAU Lead); Worcestershire Royal Hospital: Rose Johnson (ED Lead), David Pitcher (Cardiology Lead), Sue Amos (Chest Pain Nurse), Sally Baker (Chest Pain Nurse).
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