• Jessica Holly, David Hamilton, Joseph Bledsoe, Kathryn Black, Riann Robbins, Virgil Davis, Erik Barton, and Troy Madsen.
• Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
• Crit Pathw Cardiol. 2012 Mar 1;11(1):10-3.

BackgroundEmergency department observation units (EDOUs) serve an important role in the evaluation and risk stratification of low-risk chest pain patients.ObjectivesOur goal was to evaluate our EDOU protocol for intermediate-risk chest pain patients and compare outcomes and inpatient admission rates for low-risk and intermediate-risk patients.MethodsProspective observational study with 30-day telephone follow-up for all chest pain patients admitted to our EDOU from June 1, 2009 to May 31, 2010. Our protocol for intermediate-risk chest pain patients includes patients with a self-reported history of coronary artery disease and negative initial cardiac testing in the emergency department. The EDOU protocol involves telemetry, serial cardiac biomarker testing, and mandatory cardiology consultation.ResultsA total of 552 chest pain patients were evaluated, including 100 (18.1%) intermediate-risk and 452 (81.9%) low-risk patients. Intermediate-risk chest pain patients were significantly more likely to have a myocardial infarction or undergo revascularization (stent or coronary artery bypass graft) (8.0% vs. 2.2%, P = 0.008). Intermediate-risk patients had a higher inpatient admission rate (16.0% vs. 8.8%, P = 0.032). There were no significant unanticipated adverse events at 30-day follow-up in either group.ConclusionsIn conclusion, intermediate-risk chest pain patients in an EDOU had higher rates of significant cardiac events and inpatient admission. Intermediate-risk patients may be appropriate for EDOU placement, given the acceptable inpatient admission rate and the lack of significant adverse events in the 30-day follow-up period. However, given the higher rate of significant cardiac events, the results of our study emphasize the need for increased vigilance and close cardiology consultation in the intermediate-risk group.

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