The undifferentiated patient population with acute chest pain not only causes diagnostic difficulties to the health care practitioners but also requires substantial economic expenses of the department for conducting all the necessary measurement procedures and evaluating the achieved results. The organization of a CPU with all the necessary equipment and qualified personnel in the hospital setting has proven to be more effective as compared to the monitoring of patients in the traditional setting.
The innovative CPU approach to diagnosing the patients whose symptoms can be consistent with ACS helps not only in early diagnosing of the patient population and developing effective intervention programs for them but also for distributing health care resources more reasonably and increasing the patients’ satisfaction with the services. Though the implementation of the innovative CPU method requires reorganization of the whole hospital setting or ED, acquiring the equipment, and training the personnel, all the expenses are justified with the following effectiveness of the method which would allow economizing costs because of a shorter period of monitoring procedures and a much smaller rate of adverse cardiac events among the patients who were discharged after testing at a CPU.
The contemporary evidence-based approach to the choice of health care strategies requires a comprehensive review of academic resources concerning the effectiveness of the implementation of the CPU approach at other sites before proceeding to the realization of the plan. A number of recent studies have demonstrated that the organization of a CPU allowed minimizing the risks of misdiagnosing, lowering the rate of the adverse cardiac events in the discharged patient population as well as cutting the costs on the monitoring and treating the patients with acute chest pain which can be consistent with ACS or not. At the same time, it is important to develop an appropriate evaluation plan for the purpose of estimating the effectiveness of the approach in a particular medical setting as well as for making the improvements after analyzing the results if necessary. The rate of misdiagnosing of the patients with cardiac diseases in a CPU as compared to the same data in the traditional hospital setting, the costs for diagnosing and treating of one patient, and the level of health care customers’ satisfaction with the quality of the provided services are the main criteria for assessment of the effectiveness of the reorganization of the hospital setting and organization of a CPU. It is important to explore all the available opportunities and estimate the potential risks before proceeding to the implementation of the innovative approach.
At present, the traditional method of monitoring the patient population with acute chest pain whose symptoms can be consistent with ACS or other cardiac diseases at the hospital setting or ED is regarded as obsolete. There is evidence that in the nearest future most traditional health care institutions will be reorganized for the purpose of organizing a CPU, enhancing the effectiveness of the work of the institution, distributing its resources more reasonably, and increasing the patients’ satisfaction with the quality of the provided services.
The use of an innovative CPU approach to monitoring and treating the patient population with acute chest pain whose symptoms can be consistent with ACS or other cardiac diseases has demonstrated a number of advantages as compared to the time-consuming and expensive traditional approach.
The main benefits of the institution from the organization of a CPU within its setting can be subdivided into the economical and practical benefits as the main two subgroups. As to the economical aspect, contemporary researchers criticize the traditional approach to monitoring within the hospital setting because of its expensiveness and ineffectiveness. Quin (2000) admitted that “ED physicians have a low threshold for admitting patients with chest pain in whom the diagnosis is not immediately clear” (p. 404). This fear of misdiagnosing is justified but results in ineffective use of the hospital resources because of the prolonged procedures of the patients’ monitoring and keeping in the setting the patient population whose symptoms of acute chest pain are not consistent with cardiac diseases. Blomkalns and Gibler (2005) noted that “The CPU has allowed physicians to condense a hospital admission into a 6- to 12-hour evaluation, risk stratification, and observation period” (p. 418). The reduction of the admission period and the more rapid diagnosing of the patients were mentioned as the main advantages of the CPU approach in a number of studies. Quin (2000) concluded that “chest pain evaluation units deliver what they promise, providing equivalent clinical outcomes to inpatient management, in a shorter time and for lower cost” (p. 406). Along with cutting the monitoring costs and minimizing the risks of misdiagnosing, the CPUs had an impact on the satisfaction of the health care consumers with the quality of the provided services (Goodacre et al, 2005). Most studies have demonstrated the improvement of the patients’ satisfaction: CPU care reduced hospital admissions, health service costs, and patient anxiety and depression, and improved patient-reported health, quality of life and satisfaction with care” (Arnold, Goodacre, & Morris, 2007, p. 462). At the same time, in particular settings, the organization of a CPU was not associated with the increased health care consumers’ satisfaction: “The ESCAPE study found no evidence that patient satisfaction was improved by the introduction of CPU and, if anything, the trend was towards reduced satisfaction” (p. 775). This discrepancy can be explained by several subjective factors of the patient population which can have an impact on their attitude to the institution and cannot be considered by researchers.
The CPU approach to monitoring the patient population with acute chest pain presupposes a number of economical and practical benefits for the institution.
References
Arnold, J., Goodacre, S., & Morris, F. (2007). Structure, process, and outcomes of chest pain units established in the ESCAPE Trial. Emergency Medicine Journal, 24(7): 462-466.
Blomkalns, A. & Gibler, W. (2005). Chest pain unit concept: Rationale and diagnostic strategies. Cardiology Clinics, 23: 411-421. Web.
Cross, E. & Goodacre, S. (2010). Patient satisfaction with chest pain unit care: Findings from the Effectiveness and Safety of Chest Pain Assessment to Prevent Emergency Admissions (ESCAPE) cluster randomized trial. Emergency Medicine Journal, 27: 774-778.
Goodacre, S. et al. (2005). Which diagnostic tests are most useful in a chest pain unit protocol? BMC Emergency Medicine, 5 (6).
Quin, G. (2000). Chest pain evaluation units. Western Journal of Medicine, 173(6): 403-407.