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Do management algorithms improve chest pain triage?
M A Fitzpatrick1, M Dodd, D Schoevers
1Department of Cardiology, Nepean Hospital, Sydney, NSW. fitzpad@wahs.health.nsw.gov.au
The Medical Journal of Australia
|December 11, 1999
Summary
Emergency department staff had poor adherence to chest pain management algorithms. However, correct algorithm use improved triage accuracy and patient outcomes, confirming their value in acute coronary syndrome risk stratification.
Area of Science:
- Emergency Medicine
- Cardiology
- Clinical Auditing
Background:
- Chest pain is a common emergency department presentation.
- Accurate risk stratification is crucial for managing suspected acute coronary syndrome (ACS).
- Management algorithms aim to standardize care and improve outcomes.
Purpose of the Study:
- To audit the utilization of chest pain management algorithms in an emergency department setting.
- To assess the impact of algorithm use on triage accuracy and patient outcomes.
Main Methods:
- Prospective study of chest pain patients in an urban teaching hospital's emergency department.
- Staff completed standardized forms incorporating risk stratification algorithms for suspected ACS.
- Assessed compliance, concordance with cardiologist review, and major cardiovascular events over four months.
Main Results:
- Algorithm use was documented in only 45% of cases.
- Concordance with cardiologist triage grouping was 70%.
- Correct algorithm use led to 92% accurate triage decisions, significantly higher than when not used (78%) or misapplied (50-77%).
- Four-month event-free rates varied by risk group, from 50% (STEMI) to 99% (low risk/non-coronary chest pain).
Conclusions:
- Adherence to management algorithms by emergency department staff was suboptimal.
- When utilized correctly, these algorithms enhance the accuracy of triage decisions.
- The study validates the NHMRC risk stratification algorithms for prognostic assessment in suspected ACS patients.