Talmage Wood, University of Utah
Health
One of the challenges facing emergency room physicians is the number of tests and procedures to be performed on patients who present with chest pain but had negative initial findings. Since heart disease ranks as the leading cause of death in the United States, hospitals have protocols to monitor patients for a period of time before discharging them. At the University Of Utah’s Emergency Department our monitoring protocol was adjusted over a year ago to mandate consultation with a cardiologist for any and all chest pain patients being observed due to negative findings, whereas prior to the adjustment patients were monitored and consulted by normal emergency room physicians or advanced care providers.
The purpose of our study was to determine how this change in the observation unit affected patients and outcomes. Specifically, we wanted to see whether the presence of mandatory cardiology consultation resulted in fewer adverse events, fewer misdiagnoses, and whether the rate and type of testing performed was affected. We performed a prospective, observational study with 30 day follow-up over a 34 month period spanning both the pre-consult and post-consult time period. In comparison of the two time periods, we found no statistically-significant differences in regards to adverse events, diagnoses, or number and type of tests performed. These results have many applications, both in determining the effectiveness of chest pain care by emergency physicians. Though not intended for an assessment of cost to patients, our findings might provide insight into cost-effectiveness of protocol being instituted. Since medical consultation with a specialist costs more than care by an emergency physician, a decrease in adverse events under care of a specialist would warrant the higher cost of mandatory consultation; our findings do not support this claim, and it will be interesting to see what follow-up findings may shed light on.