A hospital system has evaluated its medical and financial management of patients requiring ER evaluation of chest pain over the previous calendar year. In agreement with published nationally derived data, the evaluation indicates that close to 70% of subsequent hospitalizations were unnecessary, and 'acute MI' or 'unstable angina' was confirmed in no more than 40%. These patients accounted for millions of dollars in unnecessary expenditures, thereby threatening the viability of several risk contracts.
The physicians and hospitals involved have decided to adopt a decision-making tool as an adjunct to typical decision making
processes, that accomplishes several objectives:
1. To reduce the number of patients unnecessarily admitted to rule out myocardial infarction.
2. To decrease the number of patients with acute coronary ischemia who are mistakenly discharged.
3. To expedite the decision-making process using a standardized protocol with comprehensive clinical application.
4. To assure the public, patients, and payors that prompt evaluation and effective care for noncardiac diagnoses are
maintained.
5. To provide for data collection in a format that is useful for education/Quality assurance and policy making.
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