Do You Really Need to Refer that Chest Pain Patient? New Evidence Says, ‘Maybe Not’

There’s a movement afoot in urgent care for providers to practice to the upper limits of their clinical expertise—in other words, to not “degrade” the acuity of care by referring or transferring patients out of convenience or expediency when they really could be treated in the urgent care setting. Even the often-ominous chest pain should be considered a “maybe” rather than an automatic referral, based on the findings of a study conducted in Australia and just published by JAMA Internal Medicine. The researchers sought to find out whether risk stratification and point-of-care troponin testing conducted by paramedics could result in cost savings, with equivalent outcomes. The study reflected ambulance calls for 188,551 patients whose primary complaint was chest pain, with paramedics conducting prehospital point-of-care troponin testing and risk stratification. The authors estimated cost savings to be between $42.84 million and $71.84 million if prehospital discharge could be achieved for low-risk patients. While the setting—paramedic-handled ambulance calls—may not lend itself to extrapolation to office-based practices, the findings could certainly be instructive for urgent care. JUCM has looked at this issue in multiple articles. You can read Most Clinicians Are Still Not Comfortable Sending Chest Pain Patients Home with a Very Low Risk of 30-Day Major Adverse Cardiac Event (MACE) and Implementation of a Rapid Chest Pain Protocol in a Walk-In Clinic in our archive right now.