The effect of physician risk tolerance and the presence of an observation unit on decision making for ED patients with chest pain

American Journal of Emergency Medicine

Volumn 28, Issue 7, 2010, Pages 771-779

  Pines, Jesse M ^a   Isserman, Joshua A ^a   Szyld, Demian ^a   Dean, Anthony J ^a   McCusker, Christine M ^a   Hollander, Judd E ^a  

^a UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; AGED; ARTICLE; BLOOD CLOT LYSIS; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; CONTROLLED STUDY; DECISION MAKING; EMERGENCY WARD; FEMALE; HEART INFARCTION; HIGH RISK BEHAVIOR; HOSPITAL ADMISSION; HUMAN; MAJOR CLINICAL STUDY; MALE; OBSERVATION UNIT; PHYSICIAN; PRIORITY JOURNAL; PROSPECTIVE STUDY; THORAX PAIN;

ADULT; AGED; ATTITUDE OF HEALTH PERSONNEL; BURNOUT, PROFESSIONAL; CHEST PAIN; DECISION MAKING; EMERGENCY MEDICINE; EMERGENCY SERVICE, HOSPITAL; FEMALE; HOSPITAL UNITS; HUMANS; LOGISTIC MODELS; MALE; MALPRACTICE; MEDICAL STAFF, HOSPITAL; MIDDLE AGED; MULTIVARIATE ANALYSIS; OBSERVATION; PATIENT ADMISSION; PENNSYLVANIA; PHYSICIAN'S PRACTICE PATTERNS; PROSPECTIVE STUDIES; QUESTIONNAIRES; RISK ASSESSMENT; RISK-TAKING; UNCERTAINTY;

EID: 77956607730     PISSN: 07356757     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.ajem.2009.03.019     Document Type: Article

References (28)

1. Nawar E.W., Niska R.W., and Xu J. National Hospital Ambulatory Medical Care Survey: 2005 emergency department summary Adv Data 2007 1 32
2. Pope J.H., Aufderheide T.P., and Ruthazer R. Missed diagnoses of acute cardiac ischemia in the emergency department N Engl J Med 342 2000 1163 1170
3. Christenson J., Innes G., and McKnight D. Safety and efficiency of emergency department assessment of chest discomfort CMAJ 170 2004 1803 1807
4. Collinson P.O., Premachandram S., and Hashemi K. Prospective audit of incidence of prognostically important myocardial damage in patients discharged from emergency department: commentary: time for improved diagnosis and management of patients presenting with acute chest pain BMJ 320 2000 1702 1705
5. Sequist T.D., Bates D.W., and Cook E.F. Prediction of missed myocardial infarction among symptomatic outpatients without coronary heart disease Am Heart J 149 2005 74 81
6. White A.A., Wright S.W., and Blanco R. Cause-and-effect analysis of risk management files to assess patient care in the emergency department Acad Emerg Med 11 2004 1035 1041
7. The Healthcare Cost and Utilization Project Accessed January 17, 2009 at: http://hcupnet.ahrq.gov/
8. Schull M.J., Vermeulen M.J., and Stukel T.A. The risk of missed diagnosis of acute myocardial infarction associated with emergency department volume Ann Emerg Med 48 2006 647 655
9. Goodacre S., Locker T., and Morris F. How useful are clinical features in the diagnosis of acute, undifferentiated chest pain? Acad Emerg Med 9 2002 203 208
10. Limkakeng A. Jr, Gibler W.B., and Pollack C. Combination of Goldman risk and initial cardiac troponin I for emergency department chest pain patient risk stratification Acad Emerg Med 8 2001 696 702
11. Karlson B.W., Herlitz J., and Wiklund O. Early prediction of acute myocardial infarction from clinical history, examination and electrocardiogram in the emergency room Am J Cardiol 68 1991 171 175
12. Goldman L., and Kirtane A.J. Triage of patients with acute chest pain and possible cardiac ischemia: the elusive search for diagnostic perfection Ann Intern Med 139 2003 987 995
13. Miller C.D., Lindsell C.J., and Khandelwal S. Is the initial diagnostic impression of "noncardiac chest pain" adequate to exclude cardiac disease? Ann Emerg Med 44 2004 565 574
14. Anderson J.L., Adams C.D., and Antman E.M. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine Circulation 116 2007 e148 e304
15. Katz D.A., Williams G.C., and Brown R.L. Emergency physicians' fear of malpractice in evaluating patients with possible acute cardiac ischemia Ann Emerg Med 46 2005 525 533
16. Pearson S.D., Goldman L., and Orav E.J. Triage decisions for emergency department patients with chest pain: do physicians' risk attitudes make the difference? J Gen Intern Med 10 1995 557 564
17. Hollander J.E., Blomkalns A.L., and Brogan G.X. Standardized reporting guidelines for studies evaluating risk stratification of ED patients with potential acute coronary syndromes Acad Emerg Med 11 2004 1331 1340
18. Chase M., Brown A.M., and Robey J.L. Application of the TIMI risk score in ED patients with cocaine-associated chest pain Am J Emerg Med 25 9 2007 1015 1018
19. Chase M., Robey J.L., and Zogby K.E. Prospective validation of the Thrombolysis in Myocardial Infarction Risk Score in the emergency department chest pain population Ann Emerg Med 48 3 2006 252 259
20. Franks P., Williams G., and Zwanziger J. Why do physicians vary so widely in their referral rates? J Gen Intern Med 15 2000 13 168
21. Gerrity M.S., DeVellis R.F., and Earp J.A. Physicians' reactions to uncertainty in patient care. A new measure and new insights Med Care 28 1990 724 736
22. Gerrity M.S., White K.P., and DeVellis R.F. Physicians' reactions to uncertainty: refining the constructs and scales Motiv Emot 19 1995 175 191
23. Accessed on January 17, 2009 at: http://www.emreportcard.org/ Pennsylvania.aspx
24. Pines JM, Isserman JA, Hollander JE, et al. The association between physician risk tolerance and imaging use in abdominal pain. Am J Emerg Med [in press].
25. Goodacre S., Nicholl J., and Dixon S. Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care BMJ 328 7434 2004 254
26. Roberts R.R., Zalenski R.J., and Mensah E.K. Costs of an emergency department-based accelerated diagnostic protocol vs hospitalization in patients with chest pain: a randomized controlled trial JAMA 278 20 1997 1670 1676
27. Williams A.G., Jelinek G.A., and Rogers I.R. The effect on hospital admission profiles of establishing an emergency department observation ward Med J Aust 173 2000 411 414
28. Crenshaw L.A., Lindsell C.J., and Storrow A.B. An evaluation of emergency physician selection of observation unit patients Am J Emerg Med 24 2006 271 279