Cardiology Consultation Decreases Provocative Testing in an ED Observation Unit

In a before-and-after study, investigators analyzed data from a single emergency department (ED) that changed its observation unit protocol for chest pain patients from management by emergency physicians to mandatory cardiology consultation.

Rates of stress testing or coronary computed tomography angiography were lower in the 17-month period after the change than in the period before (47.1% vs. 56.5%), particularly among low-risk patients (Thrombolysis in Myocardial Infarction [TIMI] score, 0–2; 49.8% vs. 58.1%). Rates of myocardial infarction, percutaneous coronary intervention, and coronary artery bypass graft were similar in the two phases (roughly 3%). There were no “significant events” or missed diagnoses during 30-day follow-up.