The development of a chest pain center

The accurate exclusion of myocardial ischemia as the cause of acute chest pain is a clinically demanding and resource intensive process. An estimated three to five million patients present to emergency departments in the United States each year with chest pain of uncertain etiology. Emergency departmente valuation of patients presenting with acute chest pain has traditionally involved patient history, physical examination, electrocariography, and cardiac enzyme evaluation. Unfortunately these methods suffer from suboptimal sensitivity and specificity. The majority of these patients will not have myocardial ischemia as the cause of their chest pain. Out of concern for the potential complications and legal consequences of a missed diagnosis of AMI, emergency physicians commonyl recommend hospital admission for all patients at risk of acute ischemia. Resulting in unnecessary admissions and tremendous cost. The goal of this project is to develop a research-based approach to the assessment and management of chest pain patients presenting to the Emergency Department. A chest pain observation unit will be designed for out-patient evaluation of those patients at moderate to low risk of acute coronary ischemia to rule out occult cardiovascular disease. The chest pain center model presented in this project will guide this unit structure. A community outreach educational program to and a continuous quality management program was also developed