Ryan Patrick Radecki, MD, MS, is an emergency physician and informatician with Christchurch Hospital in Christchurch,
New Zealand. He is the Annals of Emergency
Medicine podcast co-host and Journal Club editor and can be found on Twitter @emlitofnote.
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4 Responses to “Safe Discharge in Non-Low Risk Chest Pain Patients”
June 18, 2018
John CharbonnetWhat does this mean, “more than 85 percent of biomarker-negative chest-pain presentations are discharged directly from the emergency department without untoward patient safety”? Are you saying that nearly 15 percent of biomarker negative chest-pain presentations are discharged directly from the emergency department WITH untoward patient outcomes? You are proud of that???
August 6, 2018
Ryan RadeckiHi John –
Good pick-up on ambiguously phrased wording allowing for the interpretation of rampant poor outcomes in our chest pain cohort.
Rather, 85% of our chest pain patients are managed as outpatient versus 15% who are managed as inpatient. We have not been able to detect, through QA review, any particular spike in mortality or morbidity associated with increasing the proportion of those managed as outpatient rather than inpatient.
– Ryan
August 14, 2018
Scott Knepper MDHi Ryan,
Love EMLitofNote btw, but essentially what I’m reading is, “We could safely discharge the majority of patients that we admit to the hospital for chest pain,” which is what all EM providers already know. What I still don’t see is the reliable way to discriminate who can safely go home in the non-low risk population, especially when we are still missing 2% of ACS in the ED.
August 16, 2018
Ryan RadeckiHi Scott –
I agree and disagree – we can send most home, even in a non-low-risk population. The trick is there’s so much heterogeneity within the non-low-risk population there’s no way to create a generalizable decision instrument to assist with disposition. It comes down an individual estimate of the pretest likelihood of ACS given the current presentation as to whether the initial biomarker rule-out in the ED is reliable, and then the specific context of the symptoms, known anatomy, and prospective follow-up when making a plan.
– Ryan