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 (approximately 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.
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 (approximately 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.
Authors: Andrea Fabbri; Cristina Bachetti; Filippo Ottani; Alice Morelli; Barbara Benazzi; Sergio Spiezia; Marco Cortigiani; Romolo Dorizzi; Allan S Jaffe; Marcello Galvani Journal: Intern Emerg Med Date: 2018-11-29 Impact factor: 3.397
Authors: Jim Christenson; Grant Innes; Douglas McKnight; Barb Boychuk; Eric Grafstein; Christopher R Thompson; Frances Rosenberg; Aslam H Anis; Ken Gin; Jessica Tilley; Hubert Wong; Joel Singer Journal: CMAJ Date: 2004-06-08 Impact factor: 8.262
Authors: Andrew D McRae; Grant Innes; Michelle Graham; Eddy Lang; James E Andruchow; Yunqi Ji; Shabnam Vatanpour; Tasnima Abedin; Hong Yang; Danielle A Southern; Dongmei Wang; Isolde Seiden-Long; Lawrence DeKoning; Peter Kavsak Journal: Acad Emerg Med Date: 2017-08-11 Impact factor: 3.451
Authors: Baris Gencer; Paul Vaucher; Lilli Herzig; François Verdon; Christiane Ruffieux; Stefan Bösner; Bernard Burnand; Thomas Bischoff; Norbert Donner-Banzhoff; Bernard Favrat Journal: BMC Med Date: 2010-01-21 Impact factor: 8.775