Chest Pain Rule to Take Low-Risk Patients Off Emergency Department Heart Monitors


Ottawa rule could free up heart monitored beds for patients with more serious illness.

Approximately one-third of patients admitted to the emergency department (ED) for chest pain could be safely take off heart monitors to help free up monitored beds for sicker patients, while also reducing wait times.

About 70% of chest pain patients who come to the ED are placed in beds with heart monitors to detect anirregular heartbeat or arrhythmia.

In a study published in theCanadian Medical Association Journal, investigators validated the Ottawa Chest Pain Cardiac Monitoring Rule, which could help take a large numbers of patients with low-risk chest pain off of heart monitors.

“Chest pain is one of the most common reasons people visit Canadian emergency departments, with around 800,000 visits a year,” said lead author Dr Venkatesh Thiruganasambandamoorthy. “Between the 2 emergency departments at The Ottawa Hospital we see around 35 cheat pain patients every day, and usually 25 are assigned to monitored beds. This rule would let us safely remove 8 patients from these beds, freeing up the monitors for other patients.”

Normally patients are taken off the heart monitor after about 8 hours, when they are discharged home, according to the authors. However, applying the Ottawa Chest Pain Cardiac Monitor Rule would allow patients to be taken off their monitors much sooner. Furthermore, if the rule is implemented upon the patient’s initial arrival, it would allow them to be redirected to a nonmonitored area of the ED.

For the study, the investigators tested whether a simple and highly-sensitive tool that was previously developed could safely and accurately predict which patients could be taken off the monitors and which patients needed to stay on the heart monitors because of an irregular heartbeat.

The investigators found that 15 of 1125 patients admitted to the Ottawa Hospital ED for chest pain between November 2013 and April 2015 experienced an irregular heartbeat during their 8-hour stay.

The results of the study showed that the rule was able to predict with 100% accuracy for the 15 patients who needed to stay on heart monitors. Furthermore, the rule indicated that 36% of 796 patients monitored during the study could have been safely taken off of the monitors.

“This rule now has the potential to take a large number of low-risk chest pain patients off of heart monitors,” said Dr Thiruganasambandamoorthy. “We started using this rule in The Ottawa Hospital emergency departments a few months ago, and we’re watching the outcomes very closely. We have also spoken to several emergency departments across the country who are excited about bringing this rule into their hospitals.”

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