Newby D E, Fox K A, Flint L L, Boon N A
Department of Cardiology, Royal Infirmary, Edinburgh, UK.
QJM. 1998 May;91(5):333-7. doi: 10.1093/qjmed/91.5.333.
The aims of the Chest Pain Clinic were: to establish rapid-access, 'same-day', referral and attendance without a waiting list; to provide a diagnosis, treatment and follow-up plan for each patient; and to optimize the use of hospitalization for appropriate patients. Prospective data were collected from 1001 consecutive General Practitioner referrals to the Chest Pain Clinic over a 22-month period. Hospital admissions were reduced from an estimated 268 to 145 patients. Without a Chest Pain Clinic service, 213 (21%) would have been admitted inappropriately, and 89 (9%) with unstable angina or myocardial infarction would potentially have been managed in the community. A firm diagnosis was provided in 92% of cases (919 patients) with 42% (418) diagnosed as having ischaemic heart disease. The provision of a Chest Pain Clinic reduces the hospitalization of patients with benign non-cardiac chest pain whilst facilitating the identification of those patients with acute coronary syndromes requiring in-patient care. The Chest Pain Clinic service has a higher diagnostic yield for ischaemic heart disease than open access exercise electrocardiography, provides the General Practitioner with a firm clinical diagnosis in over 90% of cases, and identifies those patients requiring further treatment and invasive investigation.
建立快速通道，实现“当日”转诊和就诊，无需等待名单；为每位患者提供诊断、治疗和随访计划；并优化对合适患者的住院治疗使用。在22个月的时间里，前瞻性收集了1001例连续从全科医生转诊至胸痛诊所的患者的数据。住院人数从估计的268例减少至145例。如果没有胸痛诊所服务，213例（21%）患者可能会被不适当收治，89例（9%）不稳定型心绞痛或心肌梗死患者可能会在社区接受治疗。92%的病例（919例患者）得到了明确诊断，其中42%（418例）被诊断为患有缺血性心脏病。胸痛诊所的设立减少了良性非心脏性胸痛患者的住院率，同时有助于识别那些需要住院治疗的急性冠状动脉综合征患者。胸痛诊所服务对缺血性心脏病的诊断率高于开放式运动心电图检查，在超过90%的病例中为全科医生提供了明确的临床诊断，并识别出那些需要进一步治疗和侵入性检查的患者。
