Improving resource utilization in a teaching hospital: development of a nonteaching service for chest pain admissions

Exclusion of acute coronary syndrome frequently prompts a brief hospital admission for a large proportion of patients presenting to the emergency department with chest pain. At hospitals with residency programs, the volume of such patients creates pressures on these programs because of the limit on the number of patients a resident can accept in a given period. These restrictions have been instituted by the Accreditation Council for Graduate Medical Education (ACGME). The authors hypothesized that a nonteaching service designed to identify and admit low-risk chest pain patients should reduce those pressures.

A hospitalist-directed nonteaching service (NTS) was created to admit low-risk chest pain patients at the Hospital of the University of Pennsylvania. Patients' admission service was based upon the thrombolysis in myocardial infarction (TIMI) risk score. From September 2003 to June 2004, patients (n = 113) with scores of 0 or 1 (showing low risk) were admitted to the NTS. Simultaneously, a similar group of low-risk chest pain patients (n = 205) were admitted to a traditional internal medicine resident-based service (RBS).

The NTS patients had a lower median length of stay (23 hours versus 33 hours; p < .0001) and lower median hospital charges ($8,545 versus $14,150; p < .0001) when compared with the low-risk patients on the RBS.

The development of an NTS for chest pain admissions can assist residency programs in their efforts to meet the ACGME program requirements. The TIMI risk score can be used as a tool to assist in the identification of low-risk chest pain patients.