Why Won’t Emergency Physicians Discharge Patients with a Low HEART Score from an Observation Unit without Further Evaluation?

Link to article at PubMed

Crit Pathw Cardiol. 2020 Jul 27. doi: 10.1097/HPC.0000000000000236. Online ahead of print.


BACKGROUND: The HEART score is a prospectively validated risk stratification tool for patients presenting to the Emergency Department (ED) with chest pain. Data demonstrate that patients with low HEART scores (0-3) can be safely discharged from the ED. ED physicians, however, may be reluctant to discharge patients based on the score.

OBJECTIVE: To identify specific factors why ED physicians are reluctant to discharging patients with low risk HEART scores from an ED observation unit (EDOU) without further evaluation.

METHODS: This was a single center prospective, cross-sectional analysis of ED patients from an urban ED placed in an EDOU for evaluation of chest pain, from July 1, 2016 to August 31, 2016. ED physicians completed a questionnaire that included documentation of patient HEART score and if the patient would or would not be a good candidate for outpatient stress testing or follow-up within 72 hours without further EDOU testing or consultant evaluation. Providers selected reasons why patients were not a good candidate for outpatient stress testing/follow-up.

RESULTS: There were 279 patient questionnaires completed, 42% (117/279) had a HEART score of 0-3. Within this group, 54.7% (64/117) of the patients were identified as not being good candidates for outpatient stress testing/follow-up within 72 hours because of concerns for poor follow-up (n=14), concerning risk factors (n=14), concerning symptoms (n=11), other (n=7).

CONCLUSIONS: ED physicians' in this urban ED felt that over half of patients with a low risk HEART score were not good candidates for discharge from the EDOU without further evaluation due to poor follow-up, concerning risk factors or symptoms, or co-existing conditions.

PMID:32769484 | DOI:10.1097/HPC.0000000000000236

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