O ver-triage not only drives up the cost of medical care at a time when managing health care costs seems to be the preeminent goal but also limits the availability of intensive care beds for other ED patients. While clinical research has yet to identify a diagnostic method superior to bedside judgment in determining which patients to admit for possible MI, chest pain diagnostic testing is rapidly evolving to enhance the physician's ability to better utilize resources and to more rapidly detect patients in need of acute intervention. The Multicenter Chest Pain Study Group has collected data on over 10,000 ED visits of patients with acute chest pain. H owever all of the published reports using mathematical models have included patients with ECGs diagnostic for acute MI which inflates their calculated accuracy. More relevant to current bedside practice, risk management analyses reveal that the medical record documentation of the history in particular is often inadequate.
Authorities recommend computerized dictation systems which prompt the physician to be complete.
T he ECG is the most widely used diagnostic study in the ED evaluation of chest pain. Recently published studies question the accuracy of ECG interpretation by emergency physicians, although the actual percentage of clinically significant misreads is probably low, especially when the emergency physician has specialty training or board certification in emergency medicine. Chest pain patients with abnormal ECGs are at high risk for complications requiring critical care interventions. Previously, CKMB, like CK was measured by electrophoresis, a cumbersome and relatively insensitive assay technique. The multicenter Emergency Cardiac Research Group has published several studies suggesting that serial CKMB measurements over the first 3 - 4 hours after presentation to the ED can significanlty improve the accuracy of diagnosing MI patients with nondiagnostic ECGs.