Why Have a Chest Pain Unit?

Abstract

Acute coronary syndromes are a leading cause of death in the United States with most patients presenting to the emergency department with chest pain. From the physician’s perspective, chest pain is a “high-volume, high-risk, and high-liability” symptom. From the health-care system’s perspective, chest pain evaluation is costly and difficult to complete in a timely manner using traditional approaches. To address these issues, chest pain centers have been developed as a means of providing quality care, ensuring patient safety, while maintaining cost-effectiveness. The concept of a chest pain “unit” has been expanded to a chest pain “center,” which represents a hospital-wide designation rather than a unit. Chest pain centers are now accredited based on standardized criteria that cover the full spectrum of care for acute coronary syndrome patients – from EMS to the hospital and back to the community. Within that framework, the chest pain unit generally focuses on the management of “low-risk” chest pain patients. The goal is to avoid inadvertent discharge of occult ACS patients in a cost-effective manner. This involves patient selection or risk stratification, serial testing to identify myocardial necrosis, and then provocative testing with or without imaging to identify unstable angina. Studies have shown this approach to be associated with several benefits – lower rates of missed acute coronary syndromes, reduced unnecessary inpatient admissions, reduced cost and length of stay, improved patient and physician satisfaction, improved patient quality of life, improved hospital resource utilization and inpatient bed capacity , decreased ambulance diversions, and fewer patients leaving the ED without being seen. Several of these benefits may be tied to economic benefits for the hospital, as well as benefits for those paying for health-care services. This chapter examines the justification for a chest pain unit in a hospital and its benefits to the health-care system.