Purpose The purpose of this quality improvement (QI) project is to compare the effectiveness of a rapid 90‐min chest pain screening and evaluation protocol to a 120‐min screening and evaluation protocol in determining patient readiness for hospital admission or discharge home. Data Sources The existing chest pain protocol utilized in the emergency department (ED) was revised based on a review of current research changing initial screening and reevaluation times from 120 to 90 min. A prospective comparative study of patients presenting to the ED with chest pain was performed comparing the existing chest pain protocol of 120 min (standard care) with a rapid screening evaluation protocol of 90 min. A total of 128 patients presenting to an ED in Texas with chest pain comprised the sample for this study. Conclusions There was a significant difference in the number of minutes between the groups for readiness for disposition. The average time from chest pain evaluation to readiness for disposition home, observation, or admission decreased from an average of 191 min in the standard care group to an average of 118 min in the rapid screening group. Implications for practice Use of the rapid screening and evaluation protocol decreased the time to disposition by an average of 73 min, which enhanced ED flow without influencing disposition and patient safety.

Approximately 6 million patients present to the emergency department each year for evaluation of chest pain, and 70% of chest pain presentations are noncardiac in origin. This systematic review article compares noninvasive tests (coronary computed tomography angiography and coronary calcium scoring) to determine the predictive value to detect coronary artery disease and evaluate acute coronary syndrome associated with major cardiovascular events. There was a direct correlation with major cardiovascular events to higher calcium scores indicating that coronary artery calcium scores are strong predictors of the prognosis of coronary artery disease rather than angiographic findings. Further studies are needed.

Frustration with emergency department wait times may contribute to patient delays in seeking care for subsequent episodes of chest pain and lower patient satisfaction ratings. In response to patient feedback and the dissemination of new knowledge, the existing emergency chest pain protocol was updated to include point-of-care laboratory testing and evaluation at baseline and 90 minutes. A case study was utilized to illustrate implementation of this protocol in the management of a patient presenting to the emergency department with chest pain.

No abstract