Two ECGs and a history: a guide to early hospital discharge of patients with 'chest pain? cause'.

Objectives: To shorten the stay in hospital of patients admitted with chest pain of uncertain origin, using clinical history and an unchanging ECG as a basis to inform patients on the post-take ward round of imminent discharge that same day (pending normal cardiac enzyme results), thereby facilitating actual discharge on the same day.
Design: A prospective observational study over a two-month period of consecutive patients admitted with chest pain of uncertain origin.
Setting: District general hospital in North-West England with a regional cardiothoracic centre on site.
Results: Of the 115 patients enrolled in the study (15% of acute medical admissions), 43 (37%) were identified by the investigators as likely to have normal cardiac enzymes and only one of them had evidence of important cardiac ischaemia (median actual length of stay, 3 days). The specificity of the protocol was 98%, with a sensitivity of 89%.
Conclusions: A careful clinical history taken by experienced junior staff together with two sequential ECGs, can identify patients who may be discharged within 24 hours of admission with chest pain of uncertain origin. Significant bed savings would result from the instigation of this practice, with minimal requirement for extra resources.