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Introduction of an accelerated diagnostic protocol in the assessment of emergency department patients with possible acute coronary syndrome: The N ambour S hort L ow‐ I ntermediate C hest pain project
Author(s) -
George Terry,
Ashover Sarah,
Cullen Louise,
Larsen Peter,
Gibson Jason,
Bilesky Jennifer,
Coverdale Steven,
Parsonage William
Publication year - 2013
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.12091
Subject(s) - medicine , acute coronary syndrome , emergency department , chest pain , troponin , protocol (science) , adverse effect , emergency medicine , acute pain , intensive care medicine , physical therapy , medical emergency , anesthesia , myocardial infarction , alternative medicine , pathology , psychiatry
Emergency physicians can feel pressured by opposing forces of clinical reality and the need to publish successful key performance indicators in an environment of increasing demands and cost containment. This is particularly relevant to management of patients with undifferentiated chest pain and possible acute coronary syndrome. Unreliability of clinical assessment and high risk of adverse outcomes for all concerned exist, yet national guidelines are at odds with efforts to reduce ED crowding and access block. We report findings from the N ambour S hort L ow‐ I ntermediate C hest pain risk trial, which safely introduced an accelerated diagnostic protocol with reduced ED length of stay and high patient acceptability. Over a 7‐month period, there were no major adverse cardiac events by 30 days in 19% of undifferentiated chest pain presentations with possible acute coronary syndrome discharged after normal sensitive cardiac troponin taken 2 h after presentation and scheduled to return for outpatient exercise stress test.