Emergency department patients with chest pain may safely be evaluated in the waiting room when necessary, researchers said. Among 303 patients triaged to waiting-room evaluation in a prospective study, no acute coronary syndromes were missed and adverse event rates overall were lower than among 804 patients who were assessed in conventional monitored beds, reported Frank Scheuermeyer, MD, of St. Paul’s Hospital in Vancouver, British Columbia, and colleagues online in Annals of Emergency Medicine. They also noted that the alternative to waiting-room evaluation — delaying evaluation until a monitored bed opens up — is “associated with a variety of negative outcomes,” especially for patients who may be suffering myocardial infarction.

The report described the experience at St. Paul’s Hospital with a triage system in which patients with chest pain of potentially cardiac origin were evaluated in the emergency department waiting room when no monitored beds were available. The waiting room was equipped with three curtained stretchers and a physician order-entry terminal, with some tests such as electrocardiography possible there as well.

Primary outcome: the rate of acute coronary syndrome missed in the emergency department but subsequently diagnosed within 30 days according to well-defined criteria. Other outcomes included adverse events, time to physician evaluation and ECG, revascularizations, and admission rate.

Among the 303 patients evaluated in the waiting room, 102 were never placed on a stretcher during their entire stay in the emergency department. The researchers found that the evaluations were perfect in detecting acute coronary syndrome, whether conducted in the waiting room or in monitored beds. No cases were missed during the study period, they reported.
If anything, they added, the findings show that their triage system, “combined with rapid clinical evaluation, can identify a subgroup of chest pain patients who do not require continuous cardiac monitoring and that limited ED resources can be diverted to patients with greater need and at higher clinical risk.”

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