Evaluation of an Australian chest pain assessment unit

Background: In order to mitigate the risk of missing atypical or low probability presentations of acute coronary syndromes (ACS), many hospitals have designated resources specifically for the assessment of chest pain.

Aim: This study aims to evaluate the introduction of a chest pain assessment unit (CPAU) in a North Queensland hospital.

Methods: Information on admission status, diagnosis, procedures, length of stay and chest pain representation rates was obtained for patients presenting with chest pain to the emergency department (ED) at The Townsville Hospital in the 2.5 years prior to the introduction of a CPAU in March 2007 (n = 6665). This was compared with information on chest pain patients (n = 7885) presenting to the ED in the 2.5 years after it opened.

Results: The CPAU resulted in a reduction in the percentage of 'missed' cases of ACS. The rate of people who represented with chest pain at 3 months and who ultimately received an ACS diagnosis reduced from 1.9% to 1.4%. There was an increased rate of apparently appropriate angiograms from 6.7% to 9.4% of chest pain admissions. The admission rate of ED chest pain presentations was stable as was the median length of stay (1.14-1.16 days). A relative decrease in the proportion of admitted patients diagnosed with ACS compared with those with unspecified chest pain was observed.

Conclusion: The implementation of a CPAU at The Townsville Hospital resulted in improved care of those presenting to the ED with chest pain. Further Australian CPAU evaluations are recommended.