Predictive instruments, critical care pathways, algorithms, and protocols in the rapid evaluation of chest pain

Research output: Contribution to journalArticle

Abstract

Current standards of care mandate rapid institution of therapy for patients with acute coronary syndromes. However, because the majority of patients presenting to the emergency department with chest pain are at low risk for a coronary event and its complications, appropriate management of this group is less intensive and many do not require admission. Recent studies have shown that these low-risk patients can be identified by clinical criteria on presentation, including history, physical examination, and initial ECG. Avoidance of unnecessary admission in these patients has the potential for major cost savings while maintaining effective patient care. Recent innovative approaches to the management of low-risk patients presenting with chest pain have included the application of predictive instruments, practice guidelines and related processes, and protocol-driven short stay observation units using new cardiac serum markers and early noninvasive studies (exercise testing or stress imaging). Initial reports suggest that most of these methods have the potential for reducing cost and preserving quality of care. However, effective implementation of these approaches requires acceptance and implementation by physicians to favorably affect patient care.

Original languageEnglish (US)
Pages (from-to)30-36
Number of pages7
JournalCritical Pathways in Cardiology
Volume4
Issue number1
DOIs
StatePublished - Mar 2005

Fingerprint

Critical Pathways
Critical Care
Chest Pain
Patient Care
Cost Savings
Quality of Health Care
Patient Admission
Risk Management
Standard of Care
Acute Coronary Syndrome
Practice Guidelines
Physical Examination
Hospital Emergency Service
Electrocardiography
Biomarkers
History
Observation
Exercise
Physicians
Costs and Cost Analysis

Keywords

  • Chest pain
  • Clinical practice guideline
  • Critical pathways
  • Myocardial infarction
  • Unstable angina

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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abstract = "Current standards of care mandate rapid institution of therapy for patients with acute coronary syndromes. However, because the majority of patients presenting to the emergency department with chest pain are at low risk for a coronary event and its complications, appropriate management of this group is less intensive and many do not require admission. Recent studies have shown that these low-risk patients can be identified by clinical criteria on presentation, including history, physical examination, and initial ECG. Avoidance of unnecessary admission in these patients has the potential for major cost savings while maintaining effective patient care. Recent innovative approaches to the management of low-risk patients presenting with chest pain have included the application of predictive instruments, practice guidelines and related processes, and protocol-driven short stay observation units using new cardiac serum markers and early noninvasive studies (exercise testing or stress imaging). Initial reports suggest that most of these methods have the potential for reducing cost and preserving quality of care. However, effective implementation of these approaches requires acceptance and implementation by physicians to favorably affect patient care.",
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