פוסט זה זמין גם ב:
עברית
Christopher L Jones MBBCh, MRCEM, FACEM, DipMEd, Robyn Gallagher, Paddy Quinn MBBCh, BAO, Nick S R Lan MBBS (Hons), MClinUs, MClinRes (Dist), PgDip (Dist), David-Raj Thomas MD, BSc, MPH, Christopher Wood DCRR, Christopher Lau, Weng Man Sofia Chow, Vikram Raju MBBS, FRANZCR, James M Rankin MBBS, FRACP, FCSANZ, Abdul Rahman Ihdayhid MBBS (Hons), PhD, FRACP, Glenn Arendts MBBS, MMed, PhD, FACEM
Abstract 
Objective
Moderate risk patients with chest pain and no previously diagnosed coronary artery disease (CAD) who present to ED require further risk stratification. We hypothesise that management of these patients by ED physicians can decrease length of stay (LOS), without increasing patient harm.
Methods
A prospective pilot study with comparison to a pre-intervention control group was performed on patients presenting with chest pain to an ED in Perth, Australia between May and October 2021, following the introduction of a streamlined guideline consisting of ED led decision making and early follow up. Patients had no documented CAD and were at moderate risk of major adverse cardiac events (MACE). Electronic data was used for comparison. Primary outcomes were total LOS and LOS following troponin.
Results
One hundred eighty-six patients were included. Median total LOS was reduced by 62 min, but this change was not statistically significant (482 [360–795] vs 420 [360–525] min, P = 0.06). However, a significant 60 min decrease in LOS was found following the final troponin (240 (120–571) vs 180 (135–270) min, P = 0.02). There was no difference in the rate of MACE (0% vs 2%, P = 0.50), with no myocardial infarction or death.
Conclusions
Our study suggests that patients with no pre-existing CAD can be safely managed by emergency physicians streamlining their ED management and decreasing LOS. This pathway could be used in other centres following confirmation of the results by a larger study.
Key findings
- The implementation of an ED led approach to moderate risk chest pain in patients with no previously diagnosed coronary artery disease decreased their length of stay.
- There was no significant increase in major adverse cardiac events in moderate risk patients with no coronary artery disease referred directly from ED to a rapid access chest pain clinic.
