Item Details

title

POTENTIALLY AVOIDABLE CHEST PAIN OBSERVATION UNIT UTILIZATION: ADMISSION OF VERY-LOW-RISK PATIENTS

author

Mahler, Simon A.

abstract

Chest Pain Observation Units (CPOUs) have objective criteria to prevent placement of excessively high-risk patients into these units. However, similar criteria do not exist to identify very-low-risk patients who could potentially avoid CPOU admission. The objective of this study was to quantify the potentially avoidable CPOU admission rate, examine provider variability and determine patient and provider characteristics associated with potentially avoidable CPOU utilization. We examined a consecutive cohort of chest pain patients evaluated in an ED-based CPOU using prospective and retrospective registry data. Patients were risk stratified based on the ACC/AHA framework, age, and ECG findings. Very-low-risk was defined as age < 35, provider global assessment of low-risk, and normal or non-diagnostic ECG. Patients identified as very-low-risk were considered potentially avoidable CPOU admissions. Each encounter was associated with a board certified emergency physician allowing calculation of physicians' potentially avoidable CPOU utilization rates. Patients were followed for 30 day major adverse cardiac events (MACE), defined as the composite of death, acute myocardial infarction and coronary revascularization. Over 33 months, the registry enrolled 1731 chest pain patients. The study definition of potentially avoidable CPOU admissions was met by 10.1% (95%CI: 8.7-11.6%). The median rate of provider's potentially avoidable CPOU utilization was 10% [Interquartile range: 5.9-13.6%] and varied from 1.9% to 18.4%. None of the patients with a potentially avoidable CPOU admission had a MACE within 30 days. Patient level predictors of potentially avoidable CPOU admission included male sex, chest pressure, sharp chest pain, vomiting, lightheadedness, hypertension, and hyperlipidemia. Provider level predictors included recent residency graduation (<5 years), part-time status, and moderate or high CPOU utilization.

subject

acute coronary syndrome

chest pain

observation unit

risk stratification

contributor

Bertoni, Alain G. (committee chair)

Case, Douglas L. (committee member)

Goff, David C. (committee member)

Miller, Chadwick D, (committee member)

date

2013-01-09T09:35:10Z (accessioned)

2014-01-09T09:30:11Z (available)

2012 (issued)

degree

Clinical and Population Translational Sciences (discipline)

embargo

2014-01-09 (terms)

identifier

http://hdl.handle.net/10339/37646 (uri)

language

en (iso)

publisher

Wake Forest University

type

Thesis