Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-28T13:15:11.215Z Has data issue: false hasContentIssue false
  • English
  • Français

ALaRMED: adverse events in low-risk chest pain patients receiving continuous ECG monitoring in the emergency department: a survey of Canadian emergency physicians

Published online by Cambridge University Press:  21 May 2015

Clare L. Atzema  and
Michael J. Schull
Clare L. Atzema*
Affiliation:
Division of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ont.
Michael J. Schull
Affiliation:
Division of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ont.
*
Division of Emergency Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Rm. G157, Toronto ON M4N 3M5; clare.atzema@ices.on.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

Current guidelines suggest that most patients who present to an emergency department (ED) with chest pain should be placed on a continuous electrocardiographic monitoring (CEM) device. We surveyed emergency physicians to determine their perception of current occupancy rates of CEM and to assess their attitudes toward prescribing monitors for low-risk chest pain patients in the ED.

Methods:

We conducted a cross-sectional, self-administered Internet and mail survey of a random sample of 300 members of the Canadian Association of Emergency Physicians. Main outcome measures included the perceived frequency of fully occupied monitors in the ED and physicians' willingness to forgo CEM in certain chest pain patients.

Results:

The response rate was 66% (199 respondents). The largest group of respondents (43%; 95% confidence interval [CI] 36%–50%) indicated that monitors were fully occupied 90%–100% of the time during their most recent ED shift. When asked how often they were forced to choose a patient for monitor removal because of the limited number of monitors, 52% (95% CI 45%–60%) of respondents selected 1–3 times per shift. Ninety percent (95% CI 84%–93%) of respondents indicated that they would forgo CEM in certain cardiac chest pain patients if there was good evidence that the risk of a monitor-detected adverse event was very low.

Conclusion:

Emergency physicians report that monitors are often fully occupied in Canadian EDs, and most are willing to forgo CEM in certain chest pain patients. A large prospective study of CEM in low-risk chest pain patients is warranted.

Keywords

surveychest painequipmentemergency departmentmonitor
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 5 , September 2008 , pp. 413 - 419
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1.Julian, DG, Valantine, PA, Miller, GG. Disturbances of rate, rhythm and conduction in acute myocardial infarction. Am J Med 1964;37:915–27.Google Scholar
2.Spann, JF, Moellering, RC, Haber, E, et al.Arrhythmias in acute myocardial infarction. A study utilizing an electrocardiographic monitor for automatic detection and recording of arrhythmias. N Engl J Med 2005;271:427–31.CrossRefGoogle Scholar
3.Beveridge, R, Clarke, B, Janes, L, et al.Implementation guidelines for the Canadian Emergency Department Triage and Acuity Acale (CTAS). 2003. Available: http://www.caep.ca/template .asp?id=98758372CC0F45FB826FFF49812638DD (accessed 2008 July 22).Google Scholar
4.Drew, BJ, Califf, RM, Funk, M, et al.Practice standards for electrocardiographic monitoring in hospital settings: an American Heart Association scientific statement from the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. Circulation 2004;110:2721–46.CrossRefGoogle Scholar
5.Durairaj, L, Reilly, B, Das, K, et al.Emergency department admissions to inpatient cardiac telemetry beds: a prospective cohort study of risk stratification and outcomes. Am J Med 2001;110:7–11.CrossRefGoogle ScholarPubMed
6.Hollander, JE, Valentine, SM, McCuskey, CF, et al.Are monitored telemetry beds necessary for patients with nontraumatic chest pain and normal or nonspecific electrocardiograms? Am J Cardiol 1997;79:1110–1.CrossRefGoogle ScholarPubMed
7.Hollander, JE, Sites, FD, Pollack, CV Jr, et al.Lack of utility of telemetry monitoring for identification of cardiac death and life-threatening ventricular dysrhythmias in low-risk patients with chest pain. Ann Emerg Med 2004;43:71–6.CrossRefGoogle ScholarPubMed
8.Pope, JH, Aufderheide, TP, Ruthazer, R, et al.Missed diagnoses of acute cardiac ischemia in the emergencydepartment. N Engl J Med 2000;342:1163–70.CrossRefGoogle Scholar
9.Goldman, L, Cook, E, Johnson, P, et al.Prediction of the need for intensive care in patients who come to emergency departments with acute chest pain. N Engl J Med 1996;334:1498–504.CrossRefGoogle ScholarPubMed
10.Atzema, C, Schull, MJ, Borgundvaag, B, et al.ALARMED: adverse events in low-risk patients with chest pain receiving continuous electrocardiographic monitoring in the emergency department. A pilot study. Am J Emerg Med 2006;24:62–7.CrossRefGoogle ScholarPubMed
11.Gatien, M, Perry, JJ, Stiell, IG, et al.A clinical decision rule to identify which chest pain patients can safely be removed from cardiac monitoring in the emergency department. Ann Emerg Med 2007;50:136–43.Google Scholar
12.Derlet, R, Richards, J, Kravitz, R. Frequent overcrowding in US emergency departments. Acad Emerg Med 2001;8:151–5.CrossRefGoogle ScholarPubMed
13.Schull, MJ, Szalai, JP, Schwartz, B, et al.Emergency department overcrowding following systematichospital restructuring: trends at twenty hospitals over ten years. Acad Emerg Med 2001;8:1037–43.Google Scholar
14.Lambe, S, Washington, DL, Fink, A, et al.Trends in the use and capacity of California’s emergency departments, 1990–1999. Ann Emerg Med 2002;39:389–96.Google Scholar
15.Bayley, MD, Sanford Schwartz, J, Shofer, FS, et al.The financial burden of ED congestion andhospital overcrowding for chest pain patients awaiting admission. Acad Emerg Med 2002;9:367.Google Scholar
16.Dillman, DA. Mail and Internet surveys: the tailored design method. 2nd ed. New York (NY): John Wiley & Sons; 2000.Google Scholar
17.Newgard, CD, Haukoos, JS. Advanced statistics: missing data in clinical research — part 2: multiple imputation. Acad Emerg Med 2007;14:669–78.Google ScholarPubMed
18.Rowe, B, Bond, K, Ospina, B, et al.Frequency, determinants, and impact of overcrowding on emergency departments in Canada: a national survey of emergency department directors. Health Quarterly 2007;10:32–40.Google Scholar
19.Stiell, IG, Wells, GA, Vandemheen, K, et al.The Canadian CT Head Rule for patients with minor head injury. Lancet 2001; 357:1391–6.Google Scholar
20.Hoffman, JR, Mower, WR, Wolfson, AB, et al.Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med 2000;343:94–9.Google Scholar