DOI: 10.1111/1742-6723.14360 ISSN: 1742-6731

A streamlined Emergency Department approach to moderate risk chest pain in patients with no pre‐existing coronary artery disease: A pilot study

Christopher L Jones, Robyn Gallagher, Paddy Quinn, Nick S R Lan, David‐Raj Thomas, Christopher Wood, Christopher Lau, Weng Man Sofia Chow, Vikram Raju, James M Rankin, Abdul Rahman Ihdayhid, Glenn Arendts
  • Emergency Medicine



Moderate risk patients with chest pain and no previously diagnosed coronary artery disease (CAD) who present to ED require further risk stratification. We hypothesise that management of these patients by ED physicians can decrease length of stay (LOS), without increasing patient harm.


A prospective pilot study with comparison to a pre‐intervention control group was performed on patients presenting with chest pain to an ED in Perth, Australia between May and October 2021, following the introduction of a streamlined guideline consisting of ED led decision making and early follow up. Patients had no documented CAD and were at moderate risk of major adverse cardiac events (MACE). Electronic data was used for comparison. Primary outcomes were total LOS and LOS following troponin.


One hundred eighty‐six patients were included. Median total LOS was reduced by 62 min, but this change was not statistically significant (482 [360–795] vs 420 [360–525] min, P = 0.06). However, a significant 60 min decrease in LOS was found following the final troponin (240 (120–571) vs 180 (135–270) min, P = 0.02). There was no difference in the rate of MACE (0% vs 2%, P = 0.50), with no myocardial infarction or death.


Our study suggests that patients with no pre‐existing CAD can be safely managed by emergency physicians streamlining their ED management and decreasing LOS. This pathway could be used in other centres following confirmation of the results by a larger study.

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