Coronary Artery DiseaseLessons learned from a community hospital chest pain center
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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Part 9: Acute coronary syndromes: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations
2010, ResuscitationCitation Excerpt :One large case-control multicentre study showed that care in CPUs did not reduce the proportion of patients with chest pain admitted to hospital and may have increased ED attendances when implemented across a healthcare system (LOE 2).196 Fifty-five studies from many healthcare settings demonstrate that CPUs enable evaluation of patients systematically, with a short length of stay, high diagnostic accuracy, and a low event rate at follow-up (LOE 4).197–246 In patients with suspicion for ACS, normal initial biomarkers and non-ischaemic ECG, chest pain (observation) protocols may be recommended as a safe and effective strategy for evaluating patients in the ED.
Pain Management in the Nursing Home
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Emergency nontraumatic chest pain: Use of stress echocardiography to detect significant coronary artery stenosis
2005, Journal of the American Society of EchocardiographyStress echo in chest pain unit: The SPEED trial
2005, International Journal of CardiologyPredictors of short-term outcome in acute chest pain without ST-segment elevation
2003, International Journal of CardiologyChest pain units. Organization and protocol for the diagnosis of acute coronary syndromes
2002, Revista Espanola de Cardiologia