Clinical effectiveness evaluation of an emergency department cardiac decision unit

The aim was to test the feasibility of using automated data, and evaluate the impact of an emergency cardiac decision unit (CDU) on the overall outcomes of patients seen for chest discomfort. We used a retrospective, quasi‐experimental design to identify patients who had cardiac enzymes measured and an electrocardiogram performed during an ED visit in two six‐month periods, pre‐CDU (1 January‐30 June 1995) and post‐CDU (1 January‐ 30 June 1996). A total of 4,336 patients had outcomes assessed. After opening, 14.8 per cent of all chest pain cases were treated in the CDU. Hospital admission rates were reduced from 81.1 per cent to 66.7 per cent. Length of stay, myocardial infarction rates, and mortality were unchanged. The 14‐day revisit rates increased from 5.3 per cent to 10.3 per cent. We conclude that cardiac decision units decrease hospital admissions but increase ED revisit rates as a consequence of this now frequently used care pathway.