Chest pain? New system decides if you need ER

Many of us know someone who has experienced severe chest pain but hemmed and hawed over whether to go to the emergency room. The ultimate hope is that the pain will just pass.

The rule of thumb has been to just go--better safe than sorry. But only 20 percent of those who do go actually have heart attacks, so researchers at the Stanford Cardiac Rehabilitation Program have developed a 3- to 5-minute survey that can be administered by a health care professional that helps identify symptoms, level of heart attack risk, and whether a trip to the ER is necessary.

Because every minute counts, a case could be made that waiting around to take a survey could cost lives. But there's no reason this survey--which can be completed by phone, or in the hospital--couldn't be taken en route to the hospital.

"By streamlining the decision-making process, this system hastens the care of high-risk patients and provides more convenient care options for patients at moderate or low risk," says Robert DeBusk, founder of the program at Stanford, which works to develop effective methods of managing chronic diseases.

In November, the team published the results of the first three studies they conducted to evaluate the tool in the journal Circulation: Cardiovascular Quality and Outcomes.

To test the survey, the researchers recruited 20 healthy volunteers to use a script to report symptoms. Meanwhile, eight cardiologists and 12 cardiac nurses used the online questionnaire to determine symptoms by telephone. They input the answers into the system in real time, and based on guidelines developed by the American College of Cardiology and the American Heart Association, it classifies patients as low, moderate, or high risk, depending on the unique combinations of reporters symptoms.

High-risk patients are advised to call 911 for immediate transport to the ER. Moderate-risk patients are scheduled for a same-day visit with their cardiologist, and low-risk patients would be scheduled for an outpatient evaluation by their cardiologist within three days.

The study showed that the nurses' performances in eliciting and recording patients' symptoms equaled the cardiologists' performances, and that it took 2.6 to 4.8 minutes to complete each survey.

Because men and women report different symptoms, it will be important to closely monitor the results of this and any other questionnaire that might instruct patients on when to go to the hospital. If it turns out that it saves men's lives but costs women's lives, or vise versa, it's back to the drawing board. Pronto.

DeBusk says, "Somebody is responsible for the patient throughout the episode of illness, beginning with the initial phone contact. We always phone the patient's physician regarding the appropriate triage decision, and we help to arrange for follow-up care."

Ultimately, he adds, "The system is designed to prevent patients from falling through the cracks."