Tool to Determine Suitability for Discharging Chest Pain Patients

From ACEP:

Washington, DC—Canadian researchers have developed the “Vancouver Chest Pain Rule,” which can be used to identify and safely discharge emergency patients with chest pain from the emergency department, following evaluation.

According to the study authors, this finding is important to relieving emergency department crowding and will improve the cost-effectiveness for certain coronary diagnostic tests, as well as reduce patient inconvenience. This study is included as an early online release from Annals of Emergency Medicine (A Clinical Prediction Rule for Early Discharge of Patients with Chest Pain).

“Patients who go to the emergency department with chest pain fall into three categories,” explains lead study author James M. Christenson, MD, FRCPC, clinical professor, department of surgery, University of British Columbia and research director, St. Paul’s Hospital Department of Emergency Medicine. “There are those who have serious symptoms and need admission and treatment, those whose pain is not related to heart problems, and those who require testing and diagnosis to rule out acute or life-threatening conditions.”

According to the findings, patients with normal cardiograms and negative blood tests (used to diagnose heart attacks) are considered at low risk for serious heart conditions and can be safely discharged without prolonged emergency department observation, expensive rule-out protocols or testing.

The Vancouver Chest Pain Rule uses age, medical history, diagnostic tests for heart disease, and pain characteristics to identify patients with chest pain but who do not have an acute heart condition. About one-third of patients screened this way are found, with minimal error, to be at very low-risk of heart problems. The Vancouver Rule reduced the number of patients who had undetected acute cardiac conditions and were discharged from 5 percent to only 1 percent in Canada.

ACEP Will Hold Scientific Symposium in New Orleans

The American College of Emergency Physicians has announced that Scientific Assembly 2006 will be held in New Orleans, Louisiana, October 15-18, 2006.

New Orleans was scheduled as the host city for Scientific Assembly 2006 seven years ago. After Hurricanes Katrina and Rita, the ACEP Board and staff questioned whether the city would still be able to play host to more than 4,000 emergency medicine professionals and exhibitors. After a recent tour of the city and convention facilities by staff, the answer came back a resounding “Yes.”

“The emergency physicians providing care during Hurricane Katrina were among the very last people to leave the city,” said ACEP President Frederick C. Blum, MD. “It’s appropriate that we are now one of the first to return.”

WI: Medical Malpractice Legislation Heads to Governor’s Desk

From the Wisconsin Hospital Association

After clearing the Assembly two weeks ago, this week the Senate passed legislation reinstating caps for non-economic damages (pain and suffering) awarded in medical malpractice cases. AB 766 reinstates caps on non-economic damages at $450,000 for adults and $550,000 for children (18 and under). The legislation is in response to the Wisconsin Supreme Court striking down Wisconsin’s cap on non-economic damages in July.

In making the case for reinstating the cap, Senator Scott Fitzgerald (R-Juneau) was quick to point out to his colleagues that, unlike some other states that limit both economic and non-economic damages, Wisconsin currently has no cap on economic damages and there is no effort to change that.

Sen. Fitzgerald said the legislation is designed to address Supreme Court Justice Crooks’ concerns about the lack of rationale behind the previous cap, when he indicated that the number seemed to be “plucked out of the sky.” Fitzgerald described to his colleagues the thoughtful process that was undertaken in crafting this legislation. “The numbers were arrived at by claims’ experience, comparison to other states and a study by Pinnacle Actuarial Resources that indicates these numbers are very close to where we need to be.”

The bill also establishes a biennial review process (every odd numbered year) for determining whether the amount of the caps is still appropriate or whether it needs to be adjusted. While six Democrats in the Assembly joined all of their Republican counterparts in voting for the bill, the vote in the Senate was strictly along party lines. However, Senator Mark Miller (D-Madison) offered an amendment to reinstate a cap at $1 million. Though the $1 million cap was not supported by WHA, and failed, it was a strong, bipartisan signal of a desire to address the issue.

“All 33 senators, Democrat and Republican, voted for a cap on Tuesday (November 8), because they recognize that Wisconsin needs damage limits to maintain access to high quality physicians and hospital care,” said WHA’s Senior Vice President Eric Borgerding. “While the cap amounts differed, I think these votes sent a very strong message, and am hopeful that a cap will eventually be reinstated in Wisconsin.”

The disagreement that remains seems to be over determining what the amount of the cap should be. Wisconsin’s Governor, Jim Doyle, in early media reports has indicated he will veto the bill. However, WHA will be working with members and the public by running radio ads asking people to contact Governor Doyle urging him to sign AB 766.

WHA’s Vice President of Government Affairs Jodi Bloch added, “We need only look to our neighbors in Illinois to witness the devastating consequences that having no caps on non-economic damages can do to health care access. We have to fight to maintain this access that up until now Wisconsinites have taken for granted.”