Low-risk classified chest pain patients: Do they need cardiac monitoring in the emergency department and can they be cared for in non-monitored beds?

Summary 

This review examines the available literature on the viability of not monitoring low-risk chest pain patients in the emergency department and whether they can be cared for in non-monitored beds either within the emergency department or a ward. All chest pain patients are triaged to monitored beds within the emergency department where they are observed awaiting test results. This often leads to delays and resource issues. This review explores whether there is a subgroup of chest pain patients who can safely be assessed in non-monitored beds within the emergency department or a ward.

Methods

A retrospective review of the literature was undertaken searching the Medline database for the period 1998–2006. All articles which discussed research on non-telemetry monitoring of low-risk classified chest pain patients within the emergency department were reviewed, with the primary outcome being any detection of life-threatening arrhythmia or death within this subgroup.

Results

There were no reports of life-threatening arrhythmias, cardiac arrests or deaths within the first admission to the emergency department for low-risk classified chest pain patients who demonstrated no electrocardiograph changes or initial Troponin enzyme rise.

Conclusion

It is proposed that a subgroup of chest pain patients can be safely assigned to a non-monitored bed, if based upon normal biochemical blood test Troponin, normal electrocardiograph, or unchanging electrocardiograph, within the emergency department, or ward if admitted.

Keywords: Emergency department, Chest pain, Telemetry, Electrocardiograph