Session S61.2

Long-Time Experience with a Dedicated Database for a Chest Pain Observation Unit

T Hilbel*, D Lossnitzer, HA Katus, E Giannitsis

University of Heidelberg
Heidelberg, Germany

Chest pain observation units are specialized emergency units for the optimal medical management of patients with acute chest pain. The objectives of chest pain observation units are to rule out heart disease or to rapidly diagnosis and provide emergency treatment of acute life threatening heart disease including myocardial infarction, acute coronary syndromes, arrhythmias or other life threatening cardio-pulmonary emergencies. Chest pain observation units as a subunit of the emergency department or as separate emergency ward were developed within the last two decades in the United States and are now part of many medical centers. In contrast to the United States, the first chest pain units in Germany were opened about five years ago. The chest pain observation unit at the Heidelberg University Medical Center was opened June 2004. The Heidelberg University Hospital normally uses only one global clinical information system for patient administration, patient clinical care and patient reporting. Soon after deployment of the Heidelberg chest pain observation unit it was realized that the existing data workflow within the global clinical information system was inadequate to manage the rapid patient access and emergency treatment pathways in the chest pain observation unit. Therefore a dedicated relational database was developed for the chest pain unit. The specialized database reflected the clinical pathway of a chest pain patient from admission to discharge. The database clients are running on all seven computers and a wireless tablet PC within the chest pain observation unit. A software connector to the global clinical information system provides sharing of data for patient admission (and patient discharge reports) and all clinical data can be inserted in symptom orientated database forms. During structured data input, the database calculates several symptom related risk scores such as the Grace Score, the CSS Angina Class, the Braunwald ACS Class, the TIMI Risk Scores for STEMI and NSTEMI, the Killip Class and others. The 12 channel ECG is sent by wireless transmission to the database. All clinical laboratory blood values are sent immediately using a HL 7 software interface. The nurses have a specialized form for the input of all vital physiological parameters (heart rate, blood pressure, oxygen saturation etc.). At the end of the patient visit, an automated patient discharge report is generated consisting of all inserted clinical and diagnostic information obtained during the chest pain stay. In addition, 3 study nurses also have simultaneous access to special study related research data in the database. From May 2005 to April 2009, 20000 Patients were entered into the Heidelberg chest pain database. The general experience with the symptom and clinical pathway orientated dedicated chest pain unit database confirms that it provides optimal support for the clinical triage and initial treatment tasks in a specialized emergency chest pain unit.

(Abstract Control Number: 252)