A Rapid Diagnostic and Treatment Center for Patients With Chest Pain in the Emergency Department

Wb, Gibler; Jp, Runyon; Rc, Levy; Sayre, Michael R.; Kacich, R; Cr, Hattemer; Hamilton, C; Jw, Gerlach; Ra, Walsh

doi:10.1016/s0196-0644(95)70347-0

Cited by 367 publications

(157 citation statements)

References 30 publications

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“…A significant reduction in the number of cases of acute myocardial infarction, which would not have been diagnosed by the conventional investigation model, has been one of the most important results obtained 4,10,12,26 . In addition to this, a smaller rate of hospitalization in the coronary unit of patients non-bearers of acute myocardial infarction or unstable angi- AMI-acute myocardial infarction; ACS-acute coronary syndrome; Indetindeterminate; ECG-electrocardiogram; UA-unstable angina; LBBB-left bundle-branch block.…”

Section: Discussionmentioning

confidence: 99%

“…The systematic diagnostic investigation model was obtained through a consensus of a group of researchers after extensive revision and discussion of same models already proposed in the medical literature 5,6,10,13 . When creating this model, not only the functional characteristics of our institution were taken into consideration, but also the necessity for a diagnosis as accurate as possible, and time cost efficiency.…”

Section: Methodsmentioning

confidence: 99%

“…However, only 10-15% of the patients who go to the emergency room with chest pain have acute myocardial infarction, and less than 1% have pulmonary embolia or aortic dissection 4,5 , but more than 50% are hospitalized for diagnostic investigation (to exclude acute myocardial infarction) 1,4,6,7 . The cost of hospitalization varies in the United States from U$2000 to U$5000 per patient 8,9 , thus, equaling a total annual cost of approximately U$6-8 billions just to exclude the diagnosis of acute myocardial infarction 10 . In addition, it is estimated that 5% of patients with chest pain and acute myocardial infarction are erroneously sent home without a diagnosis being made in the emergency room 4,11,12 , which has resulted in great expenses for physicians and hospitals in the US in malpractice law suits, (in Brazil, although no statistical data are available, one can assume this rate to be higher, due to the simple fact that in many emergency rooms no electrocardiograph or cardiologist, and often neither are present).…”

mentioning

confidence: 99%

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Chest pain in the emergency room. Importance of a systematic approach

Bassan¹,

Scofano²,

Gamarski³

et al. 2000

Arq. Bras. Cardiol.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Chest pain in the emergency room. Importance of a systematic approach

Bassan¹,

Scofano²,

Gamarski³

et al. 2000

Arq. Bras. Cardiol.

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“…A number of studies have suggested that admission to a CPU is a safe and costeffective alternative to hospital admission. [43][44][45][46][47][48] CPU have traditionally been staffed by ED physicians and/or cardiologists. In a pre-post study, Krantz and colleagues found that a CPU model, incorporating hospitalists at an academic public safety-net hospital, decreased ED LOS with no difference in 30-day cardiac event rate.…”

Section: Chest Pain Unitsmentioning

confidence: 99%

Evolving practice of hospital medicine and its impact on hospital throughput and efficiencies

Chadaga

Maher

Maller³

et al. 2012

Journal of Hospital Medicine

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Hospitalists are uniquely positioned to implement strategies to improve patient flow and efficiency. Hospital leaders have stated they expect hospitalists to comanage surgical patients, participate in observation units, and screen medical admissions, in addition to providing inpatient care for medical patients. We review how the hospitalists' role in acute inpatient care, surgical comanagement, short stay units, chest pain units, and active bed management has improved throughput and patient flow. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine

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“…76 ST-segment monitoring for 8 to 12 hours in combination with testing serum biomarkers of injury may be a costeffective way to triage patients who present to the ED with chest pain. [77][78][79][80][81] Because many of these patients do not really suffer from acute coronary syndromes, ST-segment monitoring in the ED may be less costly if it results in fewer "rule-out" MI patients being admitted to a monitored hospital unit.…”

Section: Patients In the Early Phase Of Acute Coronary Syndromes (St-mentioning

confidence: 99%

Practice Standards for ECG Monitoring in Hospital Settings: Executive Summary and Guide for Implementation

Drew

Funk

2006

Critical Care Nursing Clinics of North America

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Abstract-The goals of electrocardiographic (ECG) monitoring in hospital settings have expanded from simple heart rate and basic rhythm determination to the diagnosis of complex arrhythmias, myocardial ischemia, and prolonged QT interval. Whereas computerized arrhythmia analysis is automatic in cardiac monitoring systems, computerized ST-segment ischemia analysis is available only in newer-generation monitors, and computerized QT-interval monitoring is currently unavailable. Even in hospitals with ST-monitoring capability, ischemia monitoring is vastly underutilized by healthcare professionals. Moreover, because no computerized analysis is available for QT monitoring, healthcare professionals must determine when it is appropriate to manually measure QT intervals (eg, when a patient is started on a potentially proarrhythmic drug). The purpose of the present review is to provide 'best practices' for hospital ECG monitoring. Randomized clinical trials in this area are almost nonexistent; therefore, expert opinions are based upon clinical experience and related research in the field of electrocardiography. This consensus document encompasses all areas of hospital cardiac monitoring in both children and adults. The emphasis is on information clinicians need to know to monitor patients safely and effectively. Recommendations are made with regard to indications, timeframes, and strategies to improve the diagnostic accuracy of cardiac arrhythmia, ischemia, and QT-interval monitoring. Currently available ECG lead systems are described, and recommendations related to staffing, training, and methods to improve quality are provided. Key Words: AHA Scientific Statements Ⅲ pediatrics Ⅲ electrocardiography Ⅲ torsade de pointes Ⅲ myocardial infarction Ⅲ tachyarrhythmias Ⅲ ischemia Ⅲ antiarrhythmic agents Ⅲ long-QT syndrome S ince the introduction of electrocardiographic (ECG) monitoring in hospital units Ͼ40 years ago, 1 the goals of monitoring have expanded from simple tracking of heart rate and basic rhythm to the diagnosis of complex arrhythmias, the detection of myocardial ischemia, and the identification of a prolonged QT interval. During the same 4 decades, major improvements have occurred in cardiac monitoring systems, including computerized arrhythmia detection algorithms, STsegment/ischemia monitoring software, improved noisereduction strategies, multilead monitoring, and reduced lead sets for monitoring-derived 12-lead ECGs with a minimal number of electrodes. 2,3 Despite these advances in technology, the need for human oversight in the interpretation of ECG monitoring data is as important today as it was 40 years ago for the following reasons. First, cardiac monitor algorithms are intentionally set for high sensitivity at the expense of specificity. As a result, numerous false alarms occur that must be evaluated by healthcare professionals so that overtreatment of patients will not occur. Examples of overtreatment are reported in the The American Heart Association makes every effort to avoid any actual or potential co...

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A Rapid Diagnostic and Treatment Center for Patients With Chest Pain in the Emergency Department

Cited by 367 publications

References 30 publications

Chest pain in the emergency room. Importance of a systematic approach

Chest pain in the emergency room. Importance of a systematic approach

Evolving practice of hospital medicine and its impact on hospital throughput and efficiencies

Practice Standards for ECG Monitoring in Hospital Settings: Executive Summary and Guide for Implementation

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