Some Chest Pain Patients Can Be Safely Monitored in the Emergency Department Waiting Room - May 19, 2010

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Some Chest Pain Patients Can Be Safely Monitored in the Emergency Department Waiting Room
ADVANCE: Embargoed for release until 12:01 a.m., May 20
May 19, 2010

Some chest pain patients may be safely monitored in the emergency department waiting room during very crowded periods when no other exam rooms are available. The results of a study of 1,107 chest pain patients are published online today in Annals of Emergency Medicine ("Safety of Assessment of Patients with Potential Ischemic Chest Pain in an Emergency Department Waiting Room: A Prospective Comparative Cohort Study").

"Emergency department crowding leads to delays in patient assessment and care, and patients with chest pain may be at substantial risk of adverse outcomes when evaluation is delayed," said lead study author Frank Scheuermeyer, MD, MHSc, of the Department of Emergency Medicine at St. Paul's Hospital in Vancouver. "With careful triage and rapid physician assessment, we felt that some of these patients could be safely managed in an unmonitored waiting room. To reduce the risk associated with delayed diagnosis, we developed processes that enable emergency physicians to evaluate potentially sick patients in the waiting room when all nurse-staffed stretchers are occupied."

Researchers studied 1,107 patients with chest pain potentially related to cardiac problems, 804 who were initially assigned to a monitored bed and 303 to the waiting room due to overcrowding. The rate of acute coronary syndrome (acute myocardial infarction or unstable angina) was 11.7 percent in the monitored bed group and 7.6 percent in the waiting room group. Patients waited about 28 minutes for physician assessment in the monitored bed group and about 25 minutes in the waiting room group.

The study asserts that chest pain patients would likely have waited substantially longer for physician assessment without the waiting room assessment option. No patient with acute coronary syndrome (ACS) was inappropriately discharged from the hospital with a mistaken non-ACS diagnosis in either group. There was a low rate of adverse events.

"Every year in the U.S., six million patients come to the emergency department with chest pain," said Dr. Scheuermeyer. "Emergency department crowding sometimes makes it difficult to follow recommendations that these patients be assessed and treated rapidly. When crowding conditions are such that patients cannot make it to treatment spaces, it may be necessary to have physicians see patients as quickly as possible, wherever they are. Although this care is not ideal, it may be possible to triage chest pain patients to a waiting room and assess them rapidly in a safe manner when necessary. This strategy may help reduce crowding and preserve resources for sicker patients."

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit

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