CHAPTER 61 CHEST PAIN PROTOCOLS IN THE ED

Costs of an Emergency Department-based Accelerated Diagnostic Protocol vs. Hospitalization in Patients with Chest Pain

Roberts RR, Zalenski RJ, Mensah EK, et al. JAMA. 1997;278(20):1670–1676

BACKGROUND

In the 1990s the majority of patients presenting to the ED with chest pain were hospitalized for further diagnostic testing and risk stratification, with an estimated three million hospitalizations and an annual cost of over three billion dollars for patients ultimately found to be disease free. Previous studies suggested the utility of new cardiac biomarkers and stress testing in the ED had value in evaluating patients with suspected acute myocardial infarction (AMI), but these tools had not been evaluated in a randomized trial. This study developed and tested an accelerated ED diagnostic protocol using these tools.

OBJECTIVES

To determine if the use of an accelerated ED protocol for low-risk patients presenting with chest pain results in reduced hospital admission, cost, and length of stay (LOS) when compared to traditional hospitalization.

METHODS

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