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Clinical features in the emergency department can identify patients with suspected acute coronary syndromes who are safe for care in unmonitored hospital beds

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Abstract Background:

Standard practice for patients requiring hospital admission with suspected acute coronary syndromes (ACS) is admission to a monitored cardiology bed. The Western Hospital Chest Pain Protocol was developed to identify a subset of these patients who could be safely managed in an unmonitored bed. Aim:

The objective of this prospective study of chest pain patients classified as ‘high’ or ‘intermediate’ risk by the Agency for Health Care Policy and Research/National Health and Medical Research Council guidelines was to further evaluate the safety of this protocol. Methods:

This study was a prospective, observational, cohort study investigating the outcomes of patients admitted to hospital with suspected ACS. The primary outcome of interest was death or life-threatening arrhythmia within 24 h of hospital admission. Results:

If the Western Hospital Chest Pain Protocol had been strictly applied, there would have been one death in the group assigned to unmonitored beds (1/750; 0.13%, 95% confidence interval 0.01−0.85%) and no other life-threatening arrhythmias. Conclusion:

There is a subgroup of patients with suspected ACS who require hospital admission who can, based on clinical and biochemical features in the emergency department, be safely assigned to unmonitored beds. (Intern Med J 2004; 34: 594−597)

Keywords: chest pain; monitoring; risk stratification

Document Type: Research Article


Affiliations: Joseph Epstein Centre for Emergency Medicine Research, Western Hospital and The University of Melbourne, Melbourne, Victoria, Australia

Publication date: November 1, 2004


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