Managing potentially ischaemic chestpain and coronary care beds effectively

One of the most common reasons why patients attend emergency departments inAustralia is chest pain that is potentially due to coronary artery disease (myocardialinfarction, unstable or stable angina pectoris). A number of models for theinvestigation and treatment of these patients have been employed over the last fiveto ten years. This paper describes the evolution of a model for managing ischaemicchest pain that aims to avoid potentially preventable deaths from undiagnosedmyocardial infarction, to admit to hospital patients who could benefit from inpatienttreatment, to admit to a coronary care unit patients at significant risk ofcomplications, and to avoid inter-hospital transfer of patients. Introduction of themodel has led to an increase in the appropriate hospital admission of patients withischaemic chest pain, a marked reduction in inter-hospital transfers, and betterutilisation of coronary care beds. Unmonitored, general ward management of low riskpatients with clinical unstable angina has not resulted in compromised outcomes.