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      Who gets admitted to the Chest Pain Unit (CPU) and how do we manage them? Improving the use of the CPU in Waikato DHB, New Zealand

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      BMJ Quality Improvement Reports

      British Publishing Group

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          Abstract

          Chest pain is a commonly encountered presentation in the emergency department (ED). The chest pain unit at Waikato DHB is designed for patients with likely stable angina, who are at low risk of acute coronary syndrome (ACS), with a normal ECG and Troponin T, who have a history which is highly suggestive of coronary artery disease (CAD). Two issues were identified with patient care on the unit (1) the number of inappropriate admissions and (2) the number of inappropriate exercise tolerance tests.

          A baseline study showed that 73% of admissions did not fulfil the criteria and the majority of patients (72%) had an exercise tolerance test (ETT) irrespective of clinical picture. We delivered educational presentations to key stakeholders and the implementation of a new fast track chest pain pathway for discharging patients directly from the ED. There was an improvement in the number of patients inappropriately admitted, which fell to 61%. However, the number of inappropriate ETTs did not decrease, and were still performed on 76.9% of patients.

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          Most cited references 6

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          Evaluation of the patient with acute chest pain.

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            Assessment of recent onset chest pain or discomfort of suspected cardiac origin: summary of NICE guidance.

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              Diagnosis in General Practice. Using probabilistic reasoning.

               Jenny Doust (2008)
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                Author and article information

                Journal
                BMJ Qual Improv Rep
                BMJ Qual Improv Rep
                bmjqir
                bmjqir
                BMJ Quality Improvement Reports
                British Publishing Group
                2050-1315
                2015
                11 February 2015
                : 4
                : 1
                Affiliations
                Waikato DHB, New Zealand
                Author notes
                [Correspondence to ] Judith Jade judithjade@ 123456gmail.com
                Article
                bmjquality_uu206670.w2735
                10.1136/bmjquality.u206670.w2735
                4645697
                © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ http://creativecommons.org/licenses/by-nc/2.0/legalcode

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