Characterizing the patient flow pathway during chest pain diagnosis in an emergency department

Abstract

This paper aims to report on the practical application of a rule-out protocol that utilizes point-of-care testing (POCT) at the Royal Victoria Hospital, Belfast. The protocol is used in the emergency department (ED) for patients presenting with chest pain. Data was collected during the period 20/09/07 - 08/02/08 on 137 patients. 25.5% patients arrived by ambulance, 34.3% patients were directed to ED by their GP, while 40.2% patients were 'walk-in' patients. All patients received an electrocardiogram (ECG,) 77.4% received a chest x-ray, and 92.7% patients received one POC blood test, with only 8% receiving two POC tests. 31.4% patients were either admitted or discharged in less than 2 hours. 51% of patients were admitted, 17.6% referred to a chest pain clinic (CPC) and 30.9% discharged. The final discharge diagnosis of those admitted or sent to CPC, agreed with the initial diagnosis made in ED in 73.4% of cases. The results highlight the impact that clinical judgment has on the practical application of the protocol and on admission or discharge decisions.