Reduktion der stationären Verweildauer bei Patienten mit akutem Koronarsyndrom durch Einrichtung einer Chest Pain Unit

BACKGROUND: Providing prompt and appropriate therapy, combined with the increased economic requirements of treating patients with acute coronary syndrome (ACS), places high demands on the emergency department. The aim of the present analysis is to evaluate to what extent establishing a dedicated chest pain unit (CPU) influences the length of hospital stay in ACS patients.

METHODS: Patients presenting with suspected ACS between 05/2004 and 05/2006 to either the emergency department (ED) or the newly established CPU were retrospectively analyzed. The CPU became functional in July 2005. Data were obtained according to standardized procedures based on patient charts and all available clinical information.

RESULTS: A total of 247 patients were treated in the ED and 765 in the CPU. In the ED patient group 29 (11.7%) were diagnosed with ST elevation myocardial infarction (STEMI), 38 (15.4%) with non-ST elevation myocardial infarction (NSTEMI) and 15 (6.1%) with unstable angina pectoris (UAP), while ACS could be excluded in 165 (66.8%) patients. Patients treated in the CPU showed a higher percentage of ACS with 75 (9.8%) STEMI, 128 (16.7%) NSTEMI and 136 (17.8%) UAP patients; ACS could be excluded in 426 (55.7%) patients. The median length of hospital stay was shorter in ACS patients treated in the CPU at 5.0 days compared to 8.0 days if admitted to the ED (p<0.001). No difference in length of hospital stay was observed in UAP patients, whereas in STEMI patients admitted to the ED the time was longer at 8.0 days compared to 7.0 days if admitted to the CPU (p=0.042). A reduction from 8.0 to 6.0 days in the length of hospital stay if admitted to the CPU compared to the ED could be observed (p=0.002) in NSTEMI patients.

CONCLUSIONS: Establishing a chest pain unit with optimized diagnostic and structural processes is associated with reduced lengths of hospital stay in patients with ACS treated according to current guidelines and recommendations.