Performance assessment of an emergency department chest pain unit

Introduction and objectives. To determine the prevalence and clinical characteristics of non-traumatic chest pain, to assess the quality of treatment provided by an emergency department chest pain unit (CPU), and to provide a theoretical estimate of the size of future CPUs. Methods. This prospective study included 1000 consecutive patients with chest pain seen at a CPU and a second group comprising the remaining patients seen for other complaints. Data on the patients' clinical characteristics, final diagnosis, destination (i.e., admitted or discharged), waiting time, and length of stay were recorded. In the CPU, the door-to-ECG time, and, when referred, the door to needle time and the cloor-to-balloon time were also recorded. In considering CPU size, the number of chest pain patients and the time to admission or discharge were utilized. Results. Among 22468 visits, the prevalence of chest pain was 4.4%. Compared with other patients, those with chest pain were more frequently male, older, had to wait less time, and were admitted more often. Of the 1000 chest pain patients, 25.9% had acute coronary syndrome (ACS), 64.7% did not, and 9.4% were not diagnosed because exercise testing could not be performed. Patients with ACS were older and had more cardiovascular risk factors, but no gender difference was found. The door-to-ECG time was 10 min, the door to needle time was 26 min, and the door-to-balloon time was 51 min. One CPU stretcher is required for every 13000 emergency department visits per year. Conclusions. The prevalence of chest pain and affected patients' distinct clinical profile support the introduction of emergency department CPUs. Although there were limitations on the use of exercise testing, quality of treatment standards for ACS were achieved.