Busy emergency departments have better outcomes for patients with chest pain

23/10/2018

Busy emergency departments in Ontario that evaluate more patients with chest pain have better outcomes for patients than those with lower volumes of chest pain patients, according to a new study from ICES.

Chest pain is one of the most common reasons for emergency department visits in developed countries.

The study, published today in Circulation: Cardiovascular Quality and Outcomes, looked at multiple, large population-based databases housed at ICES. The researchers examined data on 498,291 patients who were 40 years old and older, and arrived at an emergency department in Ontario from 2008 to 2014, with chest pain and were discharged after assessment.

“Practice makes perfect. Our study showed that emergency departments that treat the highest number of patients with chest pain have the best outcomes in Ontario, which has important policy implications. There should be consideration to whether regionalization of care is possible, and to evaluate whether lessons of the high-volume centers can be transferred to lower volume centers to achieve optimal outcomes,” says Dr. Dennis Ko, a senior scientist at ICES, interventional cardiologist at Schulich Heart Centre and lead author of the study.

The researchers found that higher emergency department patient volume was associated with lower risk of death at 30 days and one year post emergency department visit. At one year after discharge, the rate of dying or having a heart attack was 4.4 per cent in the emergency departments with the lowest volume versus only 3.1 per cent in the highest volume emergency departments.

The researchers also found that patients discharged from higher volume emergency departments had higher rates of cardiologist consultations, cardiac medication use, and cardiac testing within 30 days of their emergency department assessment.

However, the investigators did find that there was an optimal threshold, after which increased volume did not lead to changes in outcomes. They estimated that to be 1,400 chest pain patients per year.

“Emergency department volume and outcomes for patients after chest pain assessment,” was published today in Circulation: Cardiovascular Quality and Outcomes.

Author block: Ko D, Dattani N, Austin PC, Schull MJ, Ross J, Wijeysundera H, Tu J, Eberg M, Koh M, and Krumholz H.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario