The American College of Cardiology is expected to visit this September to complete our reaccreditation journey as an Accredited Chest Pain with Primary PCI and Resuscitation site.  This visit will reflect on medical staff utilization of standard order sets where evidence based orders/algorithms have been prepared. Click here to review that chest pain order sets that will be surveyed if a patient is being hospitalized for chest pain/ ACS primarily. (Please try not to use general admission order sets for these individuals)

After searching for chest pain (shown in pdf), the first two order sets are commonly used by admitting physicians. If a patient is being placed in observation, a dedicated order set had been designed for your ease of use.  These three order sets all have the algorithms for stress test ordering, standard medications, and rehabilitation etc.. designed for best practice.

If you desire to put in some quick orders for non  –  specific chest pain that only has ekg, troponin, simple labs –  please use the “cardiac chest pain panel”  which does not include the entire pathway. This is to be used for  EKG, troponin, labs and nitroglycerin to initiate orders.

New as of July 14th :

  1. NEW EKG order is available.  Guidelines instruct serial ECG every 30 minutes intervals during the first hour of symptoms and new onset of symptoms.  The EKG can be relatively normal or initially nondiagnostic; if this is the case, the ECG should be repeated, especially if symptoms recur. A normal ECG does not exclude ACS and occurs in 1% to 6% of such patients.
  2. HS Troponin:
      • ED protocol – Patients presenting with chest pain – Baseline (0hr) and repeat at (1hr).
      • All other patients (despite location) developing new onset of chest pain – Baseline (0hr) and repeat at (3hr) – Rationale: if measured too soon after onset of symptoms potential for falsely low hs-TnI concentration.

Please contact Russell Firman, MD FACEP CHCQM, Physician Advisor at 315.372.4484 or Stacey Raughley, MSN, RN, CCRN-K, CPHQ, Performance Excellence Consultant and Chest Pain Coordinator at 315.448.5796 with questions.