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Emergency physicians’ attitudes toward a clinical prediction rule for the identification and early discharge of low risk patients with chest discomfort

Published online by Cambridge University Press:  21 May 2015

Cameron K. MacGougan ,
James M. Christenson ,
Grant D. Innes  and
Janet Raboud
Cameron K. MacGougan
Affiliation:
Queen’s University, Kingston, Ont.
James M. Christenson*
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC The Centre for Health Evaluation and Outcome Studies (CHEOS), St. Paul’s Hospital, Vancouver, BC
Grant D. Innes
Affiliation:
Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC The Centre for Health Evaluation and Outcome Studies (CHEOS), St. Paul’s Hospital, Vancouver, BC
Janet Raboud
Affiliation:
The Centre for Health Evaluation and Outcome Studies (CHEOS), St. Paul’s Hospital, Vancouver, BC
*
Department of Emergency Medicine, St. Paul’s Hospital, 1081 Burrard St., Vancouver BC V6Z 1Y6; jimchris@interchange.ubc.ca

Abstract

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Objectives:

To determine Canadian emergency physicians’ estimates regarding the safety and efficiency of chest discomfort management in their emergency department (ED), and their attitudes toward and perception of the need for a chest discomfort clinical prediction rule that identifies very low risk patients who are safe to discharge after a brief ED assessment.

Methods:

300 members of the Canadian Association of Emergency Physicians (CAEP) were randomly selected to receive a confidential mail survey, which invited them to provide information on current disposition of patients with chest discomfort and their opinions regarding the value of a clinical prediction rule to identify patients with chest discomfort who are safe to discharge after a brief (~2 hour) assessment.

Results:

Of the 300 physicians selected, 288 were eligible for the survey and 235 (82%) responded. Only 5% follow discharged patients to measure safe practice. Overall, 165 (70%) felt the proposed prediction rule would be very useful and 43 (18%) felt it would be useful. Almost all (94%) believed a prediction rule would be useful if it identified patients safe for discharge without increasing the current rate of missed acute myocardial infarction (estimated at 2%). Most respondents (59%) believed that a clinical prediction rule should suggest a course of action, while 30% felt it should convey a probability of disease.

Conclusions:

Canadian emergency physicians support the concept of a clinical prediction rule for the early discharge of patients with chest discomfort. Most believe that such a rule would be useful if it identified patients who are safe for discharge after a brief assessment, while maintaining current levels of safety. Future research should be aimed at deriving a clinical prediction rule to identify low risk patients who can be safely discharged after a limited emergency department evaluation.

Keywords

chest paindecision-makingclinical prediction rulesurveyemergency medicine
Type
EM Advances • Progrès De La MU
Information
Canadian Journal of Emergency Medicine , Volume 3 , Issue 2 , April 2001 , pp. 89 - 94
Copyright
Copyright © Canadian Association of Emergency Physicians 2001

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