This is how and what we are currently doing:
– Improved management of patients with chest pain and suspected acute coronary syndrome in the emergency department
Chest pain is the second most common presenting complaint at the Emergency Department (ED), accounting for about 10% of all ED visits with 8-10 million annual ED visits in the US alone. The list of differential diagnoses is long, but it is commonly the perceived likelihood of acute coronary syndrome (ACS), i.e. acute myocardial infarction or unstable angina that drives management. The fear of missing cases with ACS leads to lengthy assessments in the ED and high admission rates, constituting some 25% of all medical admissions. In the end, less than 15% of all ED chest pain patients and only about 25% of admitted chest pain patients prove to have ACS, with most causes of chest pain being benign. Many of the admissions and investigations are thereby “unnecessary,” and cause a substantial health care burden. In the US alone, the cost is estimated to be 10-13 billion dollars annually.
The aim of this project is to develop new and improved management strategies for ED chest pain patients, and to test them in routine care. The new strategies are primarily created to identify a large proportion of chest pain patients suitable for safe early discharge with no need for further cardiac testing. If successful, this will reduce ED and hospital crowding, objective testing, health care costs and will benefit both patients and the health care system.
– Role and effect of checklists in the emergency department
Checklists improved the management of simulated surgical crises in a simulated operating room. Checklists also improved the management of simulated intensive care crises in a simulated intensive care unit. The purpose of this study is to determine whether checklists improve the management of simulated medical crises in-situ in emergency departments (ED), and whether the health care personnel consider the checklists to be valuable tools. Carrying out the study in actual ED, as opposed to simulated centers, arguably increases the relevance of the study findings for clinical practice.
– The EXPECT project and database
No major assessment technology for emergency department (ED) patients is used more often than the ECG. Although the ECG is an old diagnostic method, except for a few specific conditions (eg myocardial infarction) the clinical value of different ECG findings has been remarkably little studied in ED patients. In this project, we aim to establish the large transnational EXPECT (Evaluation of Unknown Predictors of Electrocardiographic Changes – a Transnational study) database to study the clinical value of ECG in different ED patients. With the use of ECGs and clinical data from at least 200,000 ED patient visits from Lund and Helsingborg in Sweden and Odense and Esbjerg in Denmark, we will evaluate the diagnostic and prognostic value of a range of ECG findings in different medical conditions. With the size and quality of the EXPECT database, the goal is to provide results and conclusions more reliable than in any previous studies.
– Crowding and workload in the emergency department, measurement and consequences
In recent years, there has been a steady rise in the number of emergency department (ED) patient visits in Sweden, and a high ED workload (crowding) is a growing problem in Sweden and internationally. ED crowding has been associated with a decrease in quality of care and an increased risk of adverse outcomes for patients, including increased mortality, mostly in the US. Data from Europe and the rest of the world are scarce. This project aims to develop workload (crowding) measures for the Swedish and European ED environment, and to analyze the relationship between workload, patient throughput and the quality of emergency care.