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논문 기본 정보

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저자정보
Ken Monahan (Division of Cardiovascular Medicine Vanderbilt Medical Center Nashville TN USA) Margaret Pan (School of Medicine Vanderbilt Medical Center Nashville TN USA) Chinonso Opara (School of Medicine Vanderbilt Medical Center Nashville TN USA) Maame Yaa A. B. Yiadom (Department of Emergency Medicine Vanderbilt Medical Center Nashville TN USA) Daniel Munoz (Division of Cardiovascular Medicine Vanderbilt Medical Center Nashville TN USA) Benjamin B. Holmes (Division of Cardiovascular Medicine Vanderbilt Medical Center Nashville TN USA) Davis Stephen (Division of Cardiovascular Medicine Vanderbilt Medical Center Nashville TN USA) Kristopher J. Swiger (Division of Cardiovascular Medicine Vanderbilt Medical Center Nashville TN USA) Sean P. Collins (Department of Emergency Medicine Vanderbilt Medical Center Nashville TN USA)
저널정보
대한응급의학회 Clinical and Experimental Emergency Medicine Clinical and Experimental Emergency Medicine Vol.6 No.3
발행연도
2019.1
수록면
196 - 203 (8page)

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Objective Bedside consultation by cardiologists may facilitate safe discharge of selected patients from the emergency department (ED) even when admission is recommended by the History, Electrocardiogram, Age, Risk factors, Troponin (HEART) pathway. If bedside evaluation is unavailable, phone consultation between emergency physicians and cardiologists would be most impactful if the resultant disposition is discordant with the HEART pathway. We therefore evaluate discordance between actual disposition and that suggested by the HEART pathway in patients presenting to the ED with chest pain for whom cardiology consultation occurred exclusively by phone and to assess the impact of phone-consultation on disposition. Methods We performed a single-center, retrospective study of adults presenting to the ED with chest pain whose emergency physician had a phone consultation with a cardiologist. Actual disposition was abstracted from the medical record. HEART pathway category (low-risk, discharge; high-risk, admit) was derived from ED documentation. For discharged patients, major adverse cardiac events were assessed at 30 days by chart review and phone follow-up. Results For the 170 patients that had cardiologist phone consultation, discordance between actual disposition and the HEART pathway was 17%. The HEART pathway recommended admission for nearly 80% of discharged patients. Following cardiologist phone-consultation, 10% of high-risk patients were discharged, with the majority having undergone a functional study recommended by the cardiologist. At 30 days, discharged patients had experienced no episodes of major adverse cardiac events or rehospitalization for cardiac reasons. Conclusion For patients presenting to the ED with chest pain, cardiology phone-consultation has the potential to safely impact disposition, primarily by facilitating functional testing in high-risk individuals.
#Emergency service #hospital #Chest pain #Acute coronary syndrome

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참고문헌 (8)

참고문헌 신청
Owens PL / 2010 / Emergency department care in the United States: a profile of national data sources / Ann Emerg Med 56:150~165 google schola Mahler SA / 2015 / The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge / Circ Cardiovasc Qual Outcomes 8:195~203 google schola Wu WK / 2017 / Documentation of HEART score discordance between emergency physician and cardiologist evaluations of ED patients with chest pain / Am J Emerg Med 35:132~135 google schola Monahan K / 2016 / Direct cardiologist involvement in ED triage of cardiology patients / Am J Emerg Med 34:325~326 google schola Mark DG / 2018 / Performance of coronary risk scores among patients with chest pain in the emergency department / J Am Coll Cardiol 71:606~616 google schola

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