Clinical Policy for the Initial Approach to Adults Presenting With a Chief Complaint of Chest Pain, With No History of Trauma

Smith, E. L.; Braen, G. Richard; Cantrill, Stephen V.; Dalsey, William C.; Greene, Constance S; Karas, Stephen; Leibovich, Marvin; Mackey, Dineke; Molzen, George W; Pietrzak, Michael P; Sayers, Daniel G; Fesmire, Francis M.; Gibler, Brian; Murphy, Barbara A.

doi:10.1016/s0196-0644(95)70342-x

Cited by 59 publications

(3 citation statements)

References 105 publications

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“…We identified all ED patients admitted to the hospital for at least 26 hours with the diagnosis of chest pain, pneumonia, and cellulitis from August 2004 to January 2005. We chose these conditions as they are common reasons for ED presentation, have standard management guidelines, and admissions for these conditions require follow-up laboratory tests and antibiotics potentially overlooked in boarded patients (American College of Emergency Physicians, 2001; Campbell, Pierce, Burton-Macleod, & Gerami, 2005; Mandell et al, 2007; Marras & Chan, 1998; Smith et al, 1995; Stevens et al, 2005). We considered examining conditions such as syncope, abdominal pain, and trauma but concluded lack of standardized algorithms made assessment and comparison of quality of care difficult.…”

Section: Methodsmentioning

confidence: 99%

A Mixed-Methods Study of the Quality of Care Provided to Patients Boarding in the Emergency Department

et al. 2012

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Concern exists regarding care patients receive while boarding (staying in the emergency department [ED] after a decision to admit has been made). This exploratory study compares care for such ED patients under "Inpatient Responsibility" (IPR) and "ED Responsibility" (EDR) models using mixed methods. The authors abstracted quantitative data from 1,431 patient charts for ED patients admitted to two academic hospitals in 2004-2005 and interviewed 10 providers for qualitative data. The authors compared delays using logistic regression and used provider interviews to explore reasons for quantitative findings. EDR patients had more delays to receiving home medications over the first 26 hours of admission but fewer while boarding; EDR patients had fewer delayed cardiac enzymes checks. Interviews revealed that culture, resource prioritization, and systems issues made care for boarded patients challenging. A theoretically better responsibility model may not deliver better care to boarded patients because of cultural, resource prioritization, and systems issues.

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Section: Methodsmentioning

confidence: 99%

A Mixed-Methods Study of the Quality of Care Provided to Patients Boarding in the Emergency Department

et al. 2012

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“…We included patients admitted to the hospital from the ED for more than 26 hours with an admission diagnosis of chest pain, pneumonia, or cellulitis. We selected these conditions as they are common reasons for admission, guidelines exist for their care, and they require follow‐up laboratory tests and/or medications that may be delayed for boarded patients 21–26 . We used International Classification of Disease, 9th Revision (ICD‐9), codes assigned for hospital admission diagnosis to identify patients.…”

Section: Methodsmentioning

confidence: 99%

“…We adapted our instrument based on our pilot study, 6 the Harvard Emergency Department Quality study, 7 standard guidelines for the three conditions, 21–26 and the NEDSS project (e.g., by adding questions on time of home medication administration, cardiac enzyme checks, partial thromboplastin time [PTT] checks, and heparin administration) 20,27 . We refined our instrument (e.g., adding unstable vital signs to the adverse event screen) based on consultation with five board‐certified EPs and two doctoral‐level health services researchers.…”

Section: Methodsmentioning

confidence: 99%