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Cardiac Chest Pain
Clinical scenario
Suspected cardiac chest pain accounts for 2-4% attendances at the Emergency Department. Approximately 18% of these patients will be having a myocardial infarction. Around 11% of these patients will die, over half of them within the first twelve hours after symptom onset. With appropriate early treatment, many deaths can be prevented.
Audit question
How are patients presenting with undifferentiated chest pain, that is suspected to be cardiac in origin, currently managed in the Emergency Department?
Method
Retrospective audit
Sample: 50 Emergency Department patient records
Criteria
Inclusions: Patients over 25 years old coded as Cardiac chest pain (Including Angina, unstable angina, NSTEMI, ACS.)
Exclusions: STEMIs are excluded
Audits
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1st August 2008
Results
| Date | Patients | Measured | Results | Standard | Regional avg. |
|---|---|---|---|---|---|
| 01st August 2008 | Inclusions - Patients aged over 25 years with cardiac pain suspected as their primary diagnosis by the initial treating physician OR central or left-sided chest pain that was not otherwise explained. | Management of patients according to the criteria | ECG performed within 10 minutes of arrival in ED | 100 % | 64 % |
| ECG review documented did not miss significant ST or T wave abnormalities | 100 % | 77 % | |||
| Aspirin either given in ED or documented evidence of being taken prior to attendance | 100 % | 100 % | |||
| Risk stratification performed according to local guidelines | 100 % | 86 % | |||
| (Anti-thrombin or LMWH) given in to high risk patients (according to local guidance) unless contraindicated | 100 % | 74 % | |||
| Low risk CCP patients undergo a structured rule out protocol (in accordance with local policy) | 100 % | 86 % |
Comments
Some improvements in most criteria, in particular in the use of reperfusion, use of a rule out protocol and ECG within 10 mins of arrival. However, a decrease in the use of LMWH in appropriate patients.
Audit Bottom Line
Results improving almost across the board, however more work is yet to be done to achieve target, particularly in the administration of asiprin, LMWH and use of ECG.