doi:10.1016/j.jemermed.2009.08.062 Administration of Emergency Medicine INFLUENCE OF IMPLEMENTATION OF A CHEST PAIN UNIT ON ACUTE CORONARY SYNDROME OUTCOMES Mariana V. Furtado, MD, MSC,* Alíssia Cardoso,† Marcelo C. Patrício,† Ana Paula W. Rossini, MD,‡ Raquel B. Campani, MD, † Carolina Meotti,† Luiz Antônio Nasi, MD, MSC, ‡ and Carísi Anne Polanczyk, MD, SCD*† *Graduate Program in Cardiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil, †Cardiology Division and Department of Medicine, and ‡Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Reprint Address: Carísi Anne Polanczyk, MD, SCD, Cardiology Division, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Room 2060, 90035-903, Porto Alegre, RS, Brazil e Abstract—Background: Different strategies have been described to increase promptness and efficiency in the as- sessment and management of patients with acute chest pain and acute coronary syndrome (ACS) in the emergency department (ED). Objective: The objective of this study is to evaluate the results of implementing a Chest Pain Unit (CPU) to assist patients with ACS, and to determine its impact on quality of health care indexes and clinical out- comes. Methods: A study was conducted with a prospective cohort of patients admitted to the ED with a chief complaint of acute chest pain or suspected ACS at two different time periods: before (n  663) and after (n  450) introducing a CPU as part of the ED. Quality-of-care indexes analyzed in this study were adherence to a critical pathway, length of hospital stay, and hospital mortality. Results: There was increased adherence to a critical pathway during the CPU period compared to the period with no designated CPU area, including compliance with prescribing aspirin, beta- blockers, and angiotensin-converting enzyme inhibitor, and performing coronary angiography in high-risk patients. After adjustment to baseline characteristics, admissions to a CPU resulted in a 65% reduction in mortality (odds ratio 0.35; 95% confidence interval 0.14 – 0.88; p  0.03). There was no difference in median length of hospital stay, 7 days (interquartile range [IQR] 4 –12) before CPU and 6 days (IQR 4 –11) after introducing the CPU (p  0.10). Conclu- sion: In the scenario of a crowded ED, implementation of a CPU was associated with greater adherence to a critical pathway for patients with ACS, with a concomitant reduc- tion in mortality rates. © 2011 Elsevier Inc. e Keywords— chest pain unit; specialized unit; prognosis INTRODUCTION Many patients seeking emergency care due to chest pain have atypical symptoms, which makes the clinical diag- nosis of acute coronary syndrome (ACS) a challenge. Diagnosis of acute myocardial infarction (AMI) is not made in approximately 2– 6% of patients who have it, and who are inadvertently discharged from the emer- gency department (ED) with a high mortality risk. On the other hand, more than 60% of patients hospitalized for ACS are found not to have AMI or unstable angina during in-hospital assessment. Many therapies for ACS are time dependent, and are more efficient in reducing morbidity and mortality rates when started early (1). In this context, in recent years, different strategies have been described to increase promptness and effi- ciency in the assessment and management of patients with acute chest pain admitted to EDs (2,3). The imple- This study was supported by grants from the Brazilian Re- search Council (CNPq), Funding of Incentive Research (FIPE- HCPA), Rio Grande do Sul Research Foundation (FAPERGS), Brazil. RECEIVED: 17 May 2009; FINAL SUBMISSION RECEIVED: 24 August 2009; ACCEPTED: 30 August 2009 The Journal of Emergency Medicine, Vol. 40, No. 5, pp. 557–564, 2011 Copyright © 2011 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$–see front matter 557