Cardiovascular Emergencies

Strategic Leader: Frank Scheuermeyer

Vision

Efficient and safe disposition for chest pain patients in BC Emergency Departments with potential ischemic chest pain.

Long Term Goal

To integrate new and existing knowledge into a comprehensive framework for safe and efficient diagnosis and disposition of patients with potential ischemic chest pain presenting at all BC Emergency Departments; and to quantitatively measure the decrease in ED and hospital resource use by implementing such a framework.

Short Term Goals

  • To test implementation of a two-hour discharge rule for chest pain patients.
  • Implement rapid diagnostic testing of chest pain patients at triage.
  • To synthesize and implement a comprehensive clinical pathway for patients with chest pain that incorporates triage ordered testing, a validated two-hour rule-out clinical decision rule, and a six-hour strategy with rapid out-patient stress tests.
  • To find resources to follow patients in order to evaluate the strategy in St. Paul’s Hospital and in other settings in BC.

Key Partners & Stakeholders

  • UBC Department of Emergency Medicine
  • Evidence-2-Excellence
  • UBC, Division of Cardiology

Work to Date

Our team demonstrated that 5% of patients with heart attacks or unstable angina were inappropriately discharged from teaching hospitals with an inaccurate diagnosis and no follow-up. In response, St. Paul’s Hospital Department of Emergency Medicine (with the Division of Cardiology) developed a six-hour ED pathway coupled with rapid outpatient stress testing. Our outcome evaluation found that the “miss rate” was reduced to zero with a concomitant decrease in resource use. We then developed a clinical decision rule to safely and rapidly discharge patients at very low risk within two hours, while ensuring that all high-risk patients were identified. We recently validated this rule. Furthermore, we have shown that many stable chest pain patients can be assessed and treated in non-traditional low-resource care areas, preserving scarce ED resources for sicker patients. Our intentions are to actively implement these components in a synthesized pathway across Emergency Departments in BC.