Nonspecific chest pain and hospital revisits within 7?days of care: variation across emergency department, observation and inpatient visits

摘要

Patients increasingly receive care in outpatient observation services rather than being admitted to the hospital, and chest pain is the leading diagnosis among observed patients [1–4]. Chest pain can indicate a serious medical condition (e.g., acute coronary syndromes, including acute myocardial infarction [AMI] and unstable angina) or a relatively minor one (e.g., gastroesophageal reflux). Often the difference between a serious and minor condition is not readily apparent [5, 6]. A relatively small percentage of patients who present to the hospital with chest pain have acute coronary syndromes or other emergent conditions requiring inpatient care [7]. However, determining the diagnosis and appropriate course of treatment for chest pain can involve clinical evaluation, testing, and monitoring. Clinicians historically had two options: hold patients with chest pain in the emergency department (ED), or admit them to the hospital for a short stay. Observation status offers a third option, allowing more time to assess the patient’s condition.