Four years ago, MODERN HEALTHCARE reported on the small but growing contingent of hospitals developing chest pain centers within their emergency departments.
At that time, some 30 centers were up and running within acute-care hospitals, with 30 more in the planning stage.
Today, more than 550 chest pain centers exist in 49 states. And that number is expected to double in the next 12 months.
Heart disease continues to be the number one killer of Americans. This year, as many as 1.5 million people will suffer a heart attack, and one-third of those individuals will die, according to the American Heart Association.
Chest pain centers are designed to diagnose and treat patients who are stricken by myocardial ischemia (a full-blown heart attack) as well as people with less serious chest pain, which may or may not be associated with coronary disease.
Costs to develop chest pain centers vary, experts say, depending on the unit's location, the number of employees hired to staff the unit and whether the unit includes overnight observation beds.
The recent surge in the number of hospitals offering chest pain centers may have more to do with managed care and the desire to save money than anything else. More hospitals are examining ways to treat patients-preferably on an outpatient basis-without jeopardizing patient care.
Financially, U.S. hospitals could save as much as $4 billion by implementing chest pain centers in their emergency rooms, said Raymond Bahr, M.D., medical director of the coronary-care unit at St. Agnes Hospital of the City of Baltimore.
Bahr is considered a pioneer of the concept of chest pain emergency units. He helped the 392-bed hospital establish the first such center in 1981.
He is also the founder of the Baltimore-based National Association of Chest Pain Emergency Rooms, which provides hospitals with educational material on developing chest pain centers in their emergency departments.
St. Agnes initially spent $500,000 to build a unit that has a separate entrance and nursing station (Nov. 25, 1991, p. 32). The unit has seven rooms, an adjacent resuscitation room and a private elevator to the coronary-care unit. The costs included equipment and renovation of the emergency department.
Bahr says hospitals should market their chest pain centers as "user-friendly" units in the emergency department so that patients suffering from chest pain will be more inclined to come to the hospital during the early stages of a heart attack, when physicians can most effectively treat the disease with clot-busting drugs and other life-saving technology.
"The mind-set used to be that if a patient came in with chest pains, we'd bump them upstairs (to the coronary-care unit) for two to three days," he said. "Now within a short period of time, we can tell whether a patient has (heart disease).
"Hospitals are saying: Let's involve the cardiologist with the emergency room physician and together focus on the nation's number one killer," Bahr said. "It's a strategy that makes sense."
Hermann Hospital in Houston followed a similar strategy last January when it invested $270,000 to develop a chest pain center. The four-bed unit is adjacent to the 618-bed hospital's emergency room and averages 100 patients per month, 45 of whom generally are admitted overnight for tests and observation, said Helen New, nursing director of the center's clinical observation unit.
"Patients are immediately triaged and put on a fast track-those diagnosed with (myocardial ischemia) are sent to the coronary-care unit. Lower-risk patients are sent to the observation unit," she said.
Hermann developed the unit as part of its ongoing effort to better educate the community about heart disease as well as improve operations within the hospital's emergency room, she said. After nearly 11/2 years in operation, the chest pain center has streamlined patient flow from the emergency room and decreased waiting times.
Hermann officials were unable to estimate how much of the hospital's annual revenues were derived from the chest pain clinic.
In Summit, N.J., 503-bed Overlook Hospital opened a chest pain center in February 1994 in its emergency department.
Officials at the hospital said the center's primary goal is to increase public awareness about the early warning signs of a heart attack and to urge potential patients to seek treatment immediately.
Its other goal is to identify and discharge more quickly those patients who are not at risk of a heart attack-who in the past would have been admitted to the hospital's inpatient unit.
The center sees 24 to 30 patients a month, officials said. While the hospital doesn't consider it a revenue generating department, officials recognize the cost savings through fewer patient admissions and shorter hospital stays.
Michael Sniffen, Overlook's president and chief executive officer, predicted that the center will help reduce costs and draw managed-care business. "By avoiding unnecessary inpatient admissions and long-term, high-cost care for patients whose disease state is not arrested, the center will allow the hospital to operate more efficiently, making us more attractive to managed-care companies," Sniffen said.