[Acute chest pain in out-of-hours primary care]

Area of Science:

• Emergency Medicine
• Primary Care
• Clinical Triage

Context:

• Out-of-hours primary care (OOH-PC) facilities are crucial first points of contact for acute conditions in the Netherlands.
• Acute chest pain assessment is a common and critical presentation in OOH-PC settings.
• Standardized triage protocols, like the Netherlands Triage Standard, are used for initial patient urgency assessment.

Purpose:

• To evaluate the performance of the current chest pain triage protocol in OOH-PC.
• To identify areas for improvement in the triage of acute chest pain patients.
• To explore strategies for reducing over- and under-triage in OOH-PC.

Summary:

• The current chest pain assessment protocol in Dutch OOH-PC facilities demonstrates only moderate discriminatory accuracy.
• While clinical experience aids final triage decisions, significant over- and under-triage persist.
• Improvements are recommended through enhanced triage software and the integration of innovative diagnostic tools, such as troponin measurements.

Impact:

• Findings highlight the need for optimizing triage software to improve patient care for acute chest pain in OOH-PC.
• The study suggests that incorporating advanced diagnostic tools can further enhance the accuracy and safety of chest pain triage.
• Implementing these recommendations can lead to more appropriate and timely care for patients presenting with chest pain outside of regular hours.