Appraisal of the professional practices: Taken care of the acute chest pain in the emergency department

The chest pain (CP) is a motive for frequent admissions in emergency departments requiring an optimal medical care of the patient according to the recommendations of the good professional practices. The objective looked for by the medical teams is to reduce the number of the useless admissions and to improve the quality of the care. It is imperative all the more quickly and exactly in the suspicions of acute coronary syndromes (ACS) received at the emergency departments. We evaluated the practices for this important care for the patients. The guideline used for the study is the one of the HAS of 2007. The reserved method is the clinical audit. The evaluation of files was manually realized by second reading over a period of 1 week from 1st till 7 June 2008 on a sample of 42 files extracted on the motive for "chest pain". The statistical studies on the rate of troponin T positive (TnT+) and the average for turn around time (TAT) were made from the base Infocentre (R) of the laboratory. One hundred percent of the physicians answered the survey, the good guideline is quoted in 57% of the cases, the clinical examination + electrocardiogram + TnT are quoted in 100%, and the cardiological opinion is drawn in 50% of the answers. The estimated TAT of the laboratory by the physician (1 hour) is in accordance with the reality at 80%, the notion of decision-making threshold in 99th percentile for the interpretation of the TnT is quoted only by 40%. The patients are 22 men (average age: 67 years) and 20 women (average age: 78 years). The number of suspicions ACS is 18. All are ST-, 13 had an interpreted and formalized electrocardiogram (ECG), five ECG were not formalized, 24 had another motive for CP. Factors of cardiovascular risk (FCVR) were looked for and noted seven times on 13 suspect patients of ACS and only five times on 29 with CP for another motive. Forty-seven percent of the patients were hospitalized. All the 42 patients had prescribed a TnT as the only marker of cardiac damage, 13% had a TnT > 0, 1 mu g/L. The average of TnT TAT is 54 minutes. In conclusion, no lack of diagnosis of ACS was detected in the second reading of 42 files; the interpretation of ECG and FCVR is not systematically formalized. At the conclusion of this study several actions of improvement were organized and indicators of TnT TAT and rate of TnT+ were positioned. (C) 2010 Elsevier Masson SAS. All rights reserved.