Lessons learned from a community hospital chest pain center

Am J Cardiol. 1999 Apr 1;83(7):1033-7. doi: 10.1016/s0002-9149(99)00010-7.


The iterative lessons from our studies suggest that creation of a chest pain center alone will not change the practice of chest pain management by most physicians. In 1993 we established a chest pain center; in mid-1995 we established a patient management algorithm directing intermediate-risk patients to the chest pain center rather than admit them to the hospital. The creation of a chest pain center did not reduce the rate of chest pain admission by mid-1995. After the patient management algorithm was created, admittances dropped by a rate of 21% (p <0.001) and chest pain center usage increased by +1,726% (p <0.001). Among the 473 patients treated and discharged in the chest pain center after mid-1995, 333 (70%) were considered intermediate risk. No patient died after discharge from the chest pain center and there was 1 non-Q-wave myocardial infarction. We conclude that a chest pain management algorithm in a chest pain center can be safe, yet effective, for identifying high-risk patients for admission and low-risk patients for discharge.

MeSH terms

  • Aged
  • Chest Pain / diagnosis*
  • Chest Pain / economics
  • Costs and Cost Analysis
  • Critical Pathways
  • Electrocardiography
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Hospital Units* / economics
  • Hospital Units* / statistics & numerical data
  • Hospitalization / statistics & numerical data
  • Hospitals, Community / economics
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Myocardial Ischemia / diagnosis
  • Myocardial Ischemia / therapy
  • Patient Discharge
  • Risk Factors