Effectiveness and safety of chest pain assessment to prevent emergency admissions: ESCAPE cluster randomised trial

Objective: To determine whether introducing chest pain unit care reduces emergency admissions without increasing reattendances and admissions over the next 30 days. Design: Cluster randomised before and after intervention trial. Setting: 14 diverse acute hospitals in the United Kingdom. Participants Patients attending the emergency department with acute chest pain during the year before and the year after the intervention started. Intervention: Establishment of chest pain unit care compared with continuation of routine care. Main outcome measures: Proportion of chest pain attendances resulting in admission; reattendances and admissions over the next 30 days; daily emergency medical admissions (all causes); and proportion of emergency department attendances with chest pain. Results: The introduction of chest pain unit care was associated with weak evidence of an increase in emergency department attendances with chest pain (16% v 3.5%; P=0.08); no change in the proportion of chest pain attendances resulting in admission (odds ratio 0.998, 95% confidence interval 0.940 to 1.059; P=0.945); small increases in the proportion reattending (odds ratio 1.10, 1.00 to 1.21; P=0.036) or being admitted (1.30, 0.97 to 1.74; P=0.083) over the next 30 days; and evidence of increased daily medical admissions (1.7 per day, 95% confidence interval 0.8 to 2.5; P