Implementation of a rapid chest pain protocol in the emergency department: A quality improvement project.

PURPOSE: The purpose of this quality improvement (QI) project is to compare the effectiveness of a rapid 90-min chest pain screening and evaluation protocol to a 120-min screening and evaluation protocol in determining patient readiness for hospital admission or discharge home. DATA SOURCES: The existing chest pain protocol utilized in the emergency department (ED) was revised based on a review of current research changing initial screening and reevaluation times from 120 to 90 min. A prospective comparative study of patients presenting to the ED with chest pain was performed comparing the existing chest pain protocol of 120 min (standard care) with a rapid screening evaluation protocol of 90 min. A total of 128 patients presenting to an ED in Texas with chest pain comprised the sample for this study. CONCLUSIONS: There was a significant difference in the number of minutes between the groups for readiness for disposition. The average time from chest pain evaluation to readiness for disposition home, observation, or admission decreased from an average of 191 min in the standard care group to an average of 118 min in the rapid screening group. IMPLICATIONS FOR PRACTICE: Use of the rapid screening and evaluation protocol decreased the time to disposition by an average of 73 min, which enhanced ED flow without influencing disposition and patient safety.

Metastatic pleomorphic carcinoma of lung presenting as abdominal pain.

Pleomorphic carcinoma of lung is a rare subtype that has a propensity to metastasize to the small bowel. This rarely encountered tumor may present a diagnostic challenge to pathologists and result in delay that could impact clinical decisions. Lung cancer can metastasize to any organ in the body; however, clinical manifestations of metastasis to the small bowel are a relatively rare event. Because they are so rare, small-bowel metastases are usually seen only at autopsy. Clinical presentation of small-bowel metastasis of lung cancer may represent a terminal event if not recognized and surgically resolved. Prompt surgical intervention may significantly extend the life of the patient.

A positive antibody screen--an encounter with the Augustine antibody.

An antibody screen is performed on the blood of patients who may require blood transfusion. If an antibody is detected, it must be identified to avoid transfusing the patient with blood that contains the corresponding antigen. Antibody screens are also performed as part of a prenatal profile to detect antibodies that may cause hemolytic disease of the newborn. In this article we report the detection of a unique antibody to an antigen of high incidence, the anti-Augustine antibody. We describe problems that may occur when this antibody is encountered, including its identification and obtaining suitable transfusion products for the patient. A brief historical review of the clinical significance of this antibody is included in the article.