Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-26T19:55:15.107Z Has data issue: false hasContentIssue false
  • English
  • Français

A new chest pain strategy in Thunder Bay

Published online by Cambridge University Press:  21 May 2015

David Mutrie
David Mutrie*
Affiliation:
Thunder Bay Regional Hospital, Thunder Bay, Ont.

Summary:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Thunder Bay Regional Hospital (TBRH) developed a chest pain strategy (CPS) to support its emergency physicians in making the difficult clinical decisions required to properly evaluate and manage ED “chest pain” patients. This strategy was developed to ensure excellent patient care in a setting of diminished inpatient bed availability and increasing ED congestion. It focuses on rapid risk stratification, using history, electrocardiogram, physical examination and 3 new point-of-care cardiac markers: myoglobin, CK-MB mass, and cardiac troponin I.

Following the introduction of the CPS in 1997, TBRH realized significant ($500 000/yr) institutional resource savings through a 60% decrease in the admission rate of non-myocardial infarction, non-unstable angina chest pain patients, a 30% decrease in ED chest pain evaluation time, and improved ED availability of monitored stretchers. The CPS has allowed TBRH to simultaneously decrease costs and improve patient care.

Type
Controversies • Controverses
Information
Canadian Journal of Emergency Medicine , Volume 1 , Issue 1 , April 1999 , pp. 57 - 61
Copyright
Copyright © Canadian Association of Emergency Physicians 1999

References

1.Finberg, H, Scadden, D, Goldman, I.Care of patients with a low probability of acute myocardial infarction: cost effectiveness of alternatives to coronary care admission. N Engl J Med 1984;310:1301–7.Google Scholar
2.Weingarten, SR, Ermann, B, Riedinger, MS, Shah, PK, Ellrodt, AG.Selecting the best triage rules for patients hospitalized with chest pain. Am J Med 1989;318: 787–803.Google Scholar
3.Lee, TH, Juarez, G, Cook, EF, Weisberg, MC, Rouan, GW, Brand, DA, et al. Ruling out myocardial infarction: a prospective multicentre validation of a 12- hour strategy for patients at low risk. N Engl J Med 1991;324:1239–46.CrossRefGoogle Scholar
4.Roberts, RR, Zalenski, RJ, Mensah, EK, Rydman, RJ, Ciavarella, G, Gussow, L, et al. Costs of an emergency departmentbased accelerated diagnostic protocol vs hospitalization in patients with chest pain. JAMA 1995;278:1670–6.CrossRefGoogle Scholar
5.Bahr, R.Growth in chest pain emergency departments throughout the United States: a cardiologist’s spin on solving the heart attack problem. Coron Artery Dis 1995;6:827–30.CrossRefGoogle ScholarPubMed
6.McCarthy, B, Beshansky, J, D’Agostino, R, et al. Missed diagnosis of acute myocardial infarction in the emergency department: results from a multicenter study. Ann Emerg Med 1993;22:579–82.CrossRefGoogle ScholarPubMed
7.Puleo, PR, Meyer, D, Wathen, C, Tawa, CB, Wheeler, S, Hamburg, RJ, et al. Use of a rapid assay of subforms of creatine kinase MB to rule out acute myocardial infarction. N Engl J Med 1994;331: 561–6.CrossRefGoogle ScholarPubMed
8.Tatum, JL, Jesse, RL, Kontos, MC, Nicholson, CS, Schmidt, KL, Roberts, CS, et al. Comprehensive strategy for the evaluation and triage of the chest pain patient. Ann Emerg Med 1997; 29:116–25.CrossRefGoogle ScholarPubMed
9.Gornall, D, Roth, S.Serial myoglobin quatitation in the early assessment of myocardial damage: a clinical study. Clin Biochem 1996;29:379–84.CrossRefGoogle Scholar
10.Winter, R, Koster, R, Sturk, A, Sanders, G.Value of myoglobin, troponin T and CPK-MB (mass) in ruling out acute myocardial infarction in the emergency room. Circulation 1995;92:3401–7.Google Scholar
11.Antman, EM, Tanasijevic, MJ, Thompson, B, Schactman, M, McCabe, CH, Cannon, CP, et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med 1996;335: 1342–9.CrossRefGoogle ScholarPubMed
12.Keffer, J.The cardiac profile and proposed practice guideline for acute ischemic heart disease. Am J Clin Path 1997;107:398–409.CrossRefGoogle ScholarPubMed
13.Hamm, CW, Goldmann, BU, Heeschen, C, Kreymann, G, Berger, J, Meinertz, T.Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. N Engl J Med 1997;337:1648–53.CrossRefGoogle ScholarPubMed
14.Gaspoz, JM, Lee, TH, Weinstein, MC, Cook, EF, Goldman, P, Komaroff, AL, et al. Cost-effectiveness of a new short-stay unit to “rule out” acute myocardial infarction in low risk patients. J Am Coll Cardiol 1994;24:1249–55.Google Scholar