Coronary Artery Disease
Lessons learned from a community hospital chest pain center

https://doi.org/10.1016/S0002-9149(99)00010-7Get rights and content

Abstract

The iterative lessons from our studies suggest that creation of a chest pain center alone will not change the practice of chest pain management by most physicians. In 1993 we established a chest pain center; in mid-1995 we established a patient management algorithm directing intermediate-risk patients to the chest pain center rather than admit them to the hospital. The creation of a chest pain center did not reduce the rate of chest pain admission by mid-1995. After the patient management algorithm was created, admittances dropped by a rate of 21% (p <0.001) and chest pain center usage increased by +1,726% (p <0.001). Among the 473 patients treated and discharged in the chest pain center after mid-1995, 333 (70%) were considered intermediate risk. No patient died after discharge from the chest pain center and there was 1 non–Q-wave myocardial infarction. We conclude that a chest pain management algorithm in a chest pain center can be safe, yet effective, for identifying high-risk patients for admission and low-risk patients for discharge.

Section snippets

Chest pain center development

Botsford General Hospital is an acute-care community hospital in Farmington Hills, Michigan, with 338 beds. In 1993, a chest pain center was established. This included 4 beds with 2 full-time nurses. The chest pain center is located on the cardiac floor and is staffed by a full-time cardiologist and a cardiac fellow.

Patients admitted to the chest pain center were placed on a monitored bed, underwent continuous electrocardiographic recording, and, creatine phosphokinase with MB (CPK-MB) band

Results

Figure 1 shows the temporal trends from 1993 through 1996 for emergency department contacts with chest pain: the patients admitted to the hospital and patients seen in the chest pain center. The chest pain center admissions remained constant at 591 of 2,220 emergency department visits in 1993 to an average of 650 of 2,400 emergency department visits in mid-1995, a rate of 27%. After the patient management algorithm was implemented, admissions dropped in 1996 to a rate of 21%, or 470 of 2,250

Discussion

In this study, we have documented that the simple establishment of the chest pain center without an expectation for certain management strategies led to an increase in hospital resource utilization. However, by implementing a patient management algorithm, which combined the principles of best science, community ownership and input, encouragement by a physician leader, and feedback to physicians involved in chest pain evaluation, we saw a significant improvement in the triage of patients with

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