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ALaRMED: adverse events in low-risk chest pain patients receiving continuous ECG monitoring in the emergency department: a survey of Canadian emergency physicians

Published online by Cambridge University Press:  21 May 2015

Clare L. Atzema  and
Michael J. Schull
Clare L. Atzema*
Affiliation:
Division of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ont.
Michael J. Schull
Affiliation:
Division of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ont.
*
Division of Emergency Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Rm. G157, Toronto ON M4N 3M5; clare.atzema@ices.on.ca

Abstract

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Objective:

Current guidelines suggest that most patients who present to an emergency department (ED) with chest pain should be placed on a continuous electrocardiographic monitoring (CEM) device. We surveyed emergency physicians to determine their perception of current occupancy rates of CEM and to assess their attitudes toward prescribing monitors for low-risk chest pain patients in the ED.

Methods:

We conducted a cross-sectional, self-administered Internet and mail survey of a random sample of 300 members of the Canadian Association of Emergency Physicians. Main outcome measures included the perceived frequency of fully occupied monitors in the ED and physicians' willingness to forgo CEM in certain chest pain patients.

Results:

The response rate was 66% (199 respondents). The largest group of respondents (43%; 95% confidence interval [CI] 36%–50%) indicated that monitors were fully occupied 90%–100% of the time during their most recent ED shift. When asked how often they were forced to choose a patient for monitor removal because of the limited number of monitors, 52% (95% CI 45%–60%) of respondents selected 1–3 times per shift. Ninety percent (95% CI 84%–93%) of respondents indicated that they would forgo CEM in certain cardiac chest pain patients if there was good evidence that the risk of a monitor-detected adverse event was very low.

Conclusion:

Emergency physicians report that monitors are often fully occupied in Canadian EDs, and most are willing to forgo CEM in certain chest pain patients. A large prospective study of CEM in low-risk chest pain patients is warranted.

Keywords

surveychest painequipmentemergency departmentmonitor
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 5 , September 2008 , pp. 413 - 419
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

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