scholarly journals Improving Communication with Patients Discharged from the Emergency Department with Noncardiac Chest Pain: A Scoping Review with Narrative Synthesis

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Ramzi Shawahna ◽  
Aya Ghoul ◽  
Najlaa Zaid ◽  
Wassan Damrah ◽  
Mohammad Jaber
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Scoping Review ◽  
Treatment Plan ◽  
The United States ◽  
Initial Assessment ◽  
Noncardiac Chest Pain ◽  
Narrative Synthesis ◽  
Key Terms ◽  
Discharge Communication

Background. This scoping review with narrative synthesis aimed to analyze scholarly peer-reviewed articles reporting on improving communication with patients discharged from the emergency department with noncardiac chest pain and qualitatively narrate on and summarize items that can be used in guiding communication with patients discharged from the emergency department with noncardiac chest pain. Methods. The databases of EMBASE/PubMed, Scopus, COCHRANE, CInAHL/EBESCO, UW libraries, and Google Scholar were searched using relevant MeSH and key terms up to February 06, 2020. The selected articles were analyzed for their contents. Items guiding discharge communication were summarized qualitatively. Results. Twenty-five articles were eligible for full review. These were published in between 1994 and 2020. Of those, 16 (64.0%) originated from the United States and 4 (16%) used some interventional design. A total of 45 different items that could be used in guiding discharge communication with patients presenting to the emergency department with chest pain were identified from the studies included in this review. Items were grouped under 6 categories that were related to initial assessment (8 items), information on diagnosis (7 items), information on discharge (9 items), follow-up suggestions (7 items), symptoms that promote return to the emergency department (7 items), and treatment plan (7 items). Conclusion. Communication with patients discharged from the emergency department with noncardiac chest pain can be improved. Results of this investigation might be helpful in guiding quality improvement projects aimed for further improvement of communication with patients discharged from the emergency department with noncardiac chest pain.

scholarly journals Variation of Cardiac Troponin I and T Measured with Sensitive Assays in Emergency Department Patients with Noncardiac Chest Pain

2012 ◽  
Vol 58 (8) ◽  
pp. 1208-1214 ◽  
Author(s):  
Volkher Scharnhorst ◽  
Krisztina Krasznai ◽  
Marcel van 't Veer ◽  
Rolf H Michels
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Cardiac Troponin ◽  
Myocardial Necrosis ◽  
High Sensitivity ◽  
Noncardiac Chest Pain ◽  
Short Term ◽  
Coronary Syndrome ◽  
Concentration Changes

Abstract BACKGROUND New-generation high-sensitivity assays for cardiac troponin have lower detection limits and less imprecision than earlier assays. Reference 99th-percentile cutoff values for these new assays are also lower, leading to higher frequencies of positive test results. When cardiac troponin concentrations are minimally increased, serial testing allows discrimination of myocardial infarction from other causes of increased cardiac troponin. We assessed various measures of short-term variation, including absolute concentration changes, reference change values (RCVs), and indices of individuality (II) for 2 cardiac troponin assays in emergency department (ED) patients. METHODS We collected blood from patients presenting with cardiac chest pain upon arrival in the ED and 2, 6, and 12 h later. Cardiac troponin was measured with the high-sensitivity cardiac troponin T (hs-cTnT) assay (Roche Diagnostics) and a sensitive cTnI assay (Siemens Diagnostics). Cardiac troponin results from 67 patients without acute coronary syndrome or stable angina were used in calculating absolute changes in cardiac troponin, RCVs, and II. RESULTS The 95th percentiles for absolute change in cardiac troponin were 8.3 ng/L for hs-cTnT and 28 ng/L for cTnI. Within-individual and total CVs were 11% and 14% for hs-cTnT and 18% and 21% for cTnI, respectively. RCVs were 38% (hs-cTnT) and 57% (cTnI). The corresponding log-normal RCVs were +46%/−32% for hs-cTnT and +76%/−43% for cTnI. II values were 0.31 (cTnI) and 0.12 (hs-cTnT). CONCLUSIONS The short-term variations and IIs of cardiac troponin were low in ED patients free of ischemic myocardial necrosis. The detection of cardiac troponin variation exceeding reference thresholds can help to identify ED patients with acute myocardial necrosis whereas variation within these limits renders acute coronary syndrome unlikely.

scholarly journals Patient race, ethnicity, and care in the emergency department: A scoping review

CJEM ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. 245-253 ◽  
Author(s):  
Allison Owens ◽  
Brian R. Holroyd ◽  
Patrick McLane
Keyword(s):  
Emergency Department ◽  
Scoping Review ◽  
Race And Ethnicity ◽  
Research Question ◽  
The United States ◽  
Subjective Experiences ◽  
Patient Race ◽  
Abstract Screening ◽  
The Impact ◽  
Full Text Screening

ABSTRACTObjectivesHealth disparities between racial and ethnic groups have been documented in Canada, the United States, and Australia. Despite evidence that differences in emergency department (ED) care based on patient race and ethnicity exist, there are no comprehensive literature reviews in this area. The objective of this review is to provide an overview of the literature on the impact of patient ethnicity and race on the processes of ED care.MethodsA scoping review was conducted to capture the broad nature of the literature. A database search was conducted in MEDLINE/PubMed, EMBASE, CINAHL Plus, Social Sciences Citation Index, SCOPUS, and JSTOR. Five journals and reference lists of included articles were hand searched. Inclusion and exclusion criteria were defined iteratively to ensure literature captured was relevant to our research question. Data were extracted using predetermined variables, and additional extraction variables were added as familiarity with the literature developed.ResultsSearching yielded 1,157 citations, reduced to 153 following removal of duplicates, and title and abstract screening. After full-text screening, 83 articles were included. Included articles report that, in EDs, patient race and ethnicity impact analgesia, triage scores, wait times, treatments, diagnostic procedure utilization, rates of patients leaving without being seen, and patient subjective experiences. Authors of included studies propose a variety of possible causes for these disparities.ConclusionsFurther research on the existence of disparities in care within EDs is warranted to explore the causes behind observed disparities for particular health conditions and population groups in specific contexts.

Implementation of an Emergency Department High-Sensitivity Troponin Chest Pain Pathway in the United States

2019 ◽  
Vol 18 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Christopher W. Baugh ◽  
Benjamin M. Scirica ◽  
James L. Januzzi ◽  
David A. Morrow ◽  
Kent B. Lewandrowski ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
Chest Pain ◽  
High Sensitivity ◽  
The United States ◽  
High Sensitivity Troponin ◽  
Pain Pathway

Noncardiac chest pain in the emergency department: the role of cardiac history, anxiety or depression and Type D personality

2007 ◽  
Vol 14 (2) ◽  
pp. 273-279 ◽  
Author(s):  
Petra M.J.C. Kuijpers ◽  
Johan Denollet ◽  
Hein J.J. Wellens ◽  
Harry M. Crijns ◽  
Adriaan Honig
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Type D Personality ◽  
Noncardiac Chest Pain ◽  
Type D

Role of soluble and platelet-bound P-selectin in discriminating cardiac from noncardiac chest pain at presentation in the emergency department

2000 ◽  
Vol 139 (2) ◽  
pp. 0320-0328 ◽  
Author(s):  
Paul A. Gurbel ◽  
Dean J. Kereiakes ◽  
Margaret R. Dalesandro ◽  
Raymond D. Bahr ◽  
Christopher M. O[rsquo ]Connor ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Noncardiac Chest Pain

Curative versus palliative therapy for patients with colorectal cancer presenting to the emergency department.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 433-433
Author(s):  
Andy Stuart Barnett ◽  
Yiyi Chen ◽  
Zunqiu Chen ◽  
Mohamud Daya ◽  
Charles R. Thomas ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Emergency Department ◽  
Treatment Plan ◽  
The United States ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Categorical Variables ◽  
Tumor Type ◽  
Curative Intent ◽  
Emergency Presentation

433 Background: Colorectal cancer (CRC) is the second leading cause of cancer death in the United States for men and women combined, and can present emergently with symptoms such as abdominal pain, bleeding, and obstruction. Emergency presentation as the first indication of colorectal cancer is generally thought to be associated with advanced disease and poor outcome. The specific aim of this analysis was to describe characteristics of patients (pts) presenting to the Emergency Department (ED) at their index diagnosis, and to determine whether emergency presentation precludes treatment with curative intent. Methods: We performed an IRB-approved retrospective cohort analysis. We queried the prospectively maintained institutional tumor registry to identify pts diagnosed with CRC from 2008-2010. EMRs were reviewed to identify which pts presented to the ED with acute symptoms of CRC as the initial sign of their illness. The primary outcome variable was treatment plan (curative vs. palliative). Secondary outcome variables included demographics, tumor type and location. Descriptive statistics were conducted for major variables. Χ2 and Fisher’s exact tests were used to detect the association between categorical variables. Two-sample t-test was used to identify the association between continuous and categorical variables. Results: Between Jan 1 2008 and Dec 31 2010, 376 pts were identified with CRC. 214(57%) were male and 162(43%) were female, with mean age 60.6; SD: 13.3. 33 (8.8%) pts initially presented to the ED, of which 5 (15.5%) received palliation. Of 339 pts who initially presented elsewhere, 69 (20.5%) received palliation. Acute ED presentation with CRC symptoms did not preclude treatment with curative intent (p = 0.47). Pts who presented emergently were more likely to be female (64% vs male 41%; p=0.01), and older (65 vs. 60; p=0.02). There was no statistically significant relationship between age, gender, tumor location or type and treatment approach. Conclusions: Pts with CRC may present to the ED with acute symptoms, which ultimately leads to the diagnosis. Emergent presentation of CRC does not preclude patients from receiving therapy with curative intent.

Initial Appraisal of Acute Coronary Syndromes

2005 ◽  
Vol 18 (5) ◽  
pp. 377-393
Author(s):  
Roshanak Aazami
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Risk Groups ◽  
The United States ◽  
Rapid Identification ◽  
Emergency Department Care ◽  
Coronary Syndrome ◽  
Emergency Department Patients ◽  
Pharmacologic Treatments

Acute coronary syndrome remains a daunting health care problem in the United States. One third of emergency department patients with chest pain will eventually have a diagnosis of acute coronary syndrome. During the past decade, there have been many advances in the treatment of acute coronary syndrome as well as a widespread movement in emergency medicine to streamline the process of its treatment. Goals of emergency department care include rapid identification of patients with acute myocardial infarction, exclusion of causes of nonischemic chest pain, stratification of patients with acute coronary ischemia into low-risk and high-risk groups, and initiation of pharmacologic treatments. These goals will be discussed in this review, with particular emphasis on pharmacologic treatments.

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