Thunder Bay Regional Hospital (TBRH) developed a
chest pain strategy (CPS) to support its emergency physicians in making the difficult clinical decisions required to properly evaluate and manage ED "
chest pain" patients. This strategy was developed to ensure excellent patient care in a setting of diminished inpatient bed availability and increasing ED congestion. It focuses on rapid risk stratification, using history, electrocardiogram, physical examination and 3 new point-of-care cardiac markers:
myoglobin, CK-MB mass, and cardiac
troponin I. Following the introduction of the CPS in 1997, TBRH realized significant ($500 000/yr) institutional resource savings through a 60% decrease in the admission rate of non-
myocardial infarction, non-
unstable angina chest pain patients, a 30% decrease in ED
chest pain evaluation time, and improved ED availability of monitored
stretchers. The CPS has allowed TBRH to simultaneously decrease costs and improve patient care.