Feasibility of a rapid diagnostic protocol for an emergency department chest pain unit

Ann Emerg Med. 1997 Jan;29(1):99-108. doi: 10.1016/s0196-0644(97)70315-9.


Study objective: To evaluate the applicability of a short-stay protocol for exclusion of acute ischemic heart disease without hospital admission and to analyze these results in the context of a conceptual model.

Methods: An observational study of patients who presented with chest pain to the emergency department of an 886-bed inner-city municipal hospital and who needed hospital admission to rule out acute myocardial infarction (AMI). Patients were assessed by ED attending physicians to determine eligibility for an alternative, 12-hour protocol in an ED chest pain observation unit (CPOU) followed by immediate exercise testing. Outcome measures were proportion of patients eligible for the short-stay protocol, risk factor profile, and reasons for exclusion.

Results: Of 500 patients screened, 446 had sufficient data points to determine protocol eligibility. Of these, 238 (53.3%; 95% confidence interval [CI], 48.7% to 57.9%) were found to have low probability for AMI. After study exclusion criteria were applied to the patient cohort, 63 patients (14.1%; 95% CI, 10.9% to 17.3%) were eligible for the protocol. The most common reasons for exclusion were history of coronary artery disease (46%) and inability to perform an interpretable exercise tolerance test (42%).

Conclusion: Although most admitted patients with chest pain (53%) were at low probability for AMI, only a minority (14%) were eligible for a short-stay protocol that required patients to be free of known coronary artery disease and able to perform an exercise tolerance test. Factors affecting the operations and efficiency of a CPOU include clinical characteristics of the target patient population, protocol tests used, and hospital occupancy and reimbursement patterns.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Chest Pain / economics
  • Chest Pain / etiology*
  • Chicago
  • Clinical Protocols*
  • Cost-Benefit Analysis
  • Emergency Service, Hospital / economics
  • Emergency Service, Hospital / standards*
  • Feasibility Studies
  • Female
  • Hospital Bed Capacity, 500 and over
  • Hospitals, Municipal
  • Humans
  • Male
  • Middle Aged
  • Models, Theoretical
  • Myocardial Infarction / complications
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / economics
  • Outcome and Process Assessment, Health Care*
  • Pain Clinics / economics
  • Pain Clinics / standards*
  • Patient Selection
  • Risk
  • Risk Factors