Chest Pain Observation Unit



Dr. Frantz Gibbs, medical director of the Anderson Emergency Center at Rhode Island Hospital, rounding on patients in the Chest Pain Observation Unit





Dr. Anthony Napoli, MD: Chest Pain Unit DirectorDr. Anthony Napoli, MD: Chest Pain Unit Director

Acute myocardial infarction is the leading cause of death in the United States. Advances in clinical practice, cardiac biomarkers, and early risk stratification have led to improved identification of at risk chest pain patients by way of evidence based management algorithms.

The mission of the Rhode Island Hospital Chest Pain Observation Unit (CPU) is to improve the detection of subtle acute coronary syndrome while improving the care provided to chest pain patients through efficient, evidence-based management plans.

The Rhode Island Hospital Chest Pain Observation Unit, accredited by
the Society of Cardiovascular Patient Care, is an observation unit for the workup and management of patients with low to moderate risk chest pain suspicious for ischemic cardiac disease.

This 7-bed unit lies within the emergency department and functions 24 hours a day, 7 days a week. It is staffed by emergency physicians, nurses, and mid-level providers with consultative services provided by Cardiology. Patients admitted to this unit generally are targeted for serial cardiac biomarkers, serial ECGs, observation and re-examination, and selective use of stress testing.

The average length of stay is 17 hours with 90 percent of patients discharged within the first 24 hours. The average annual census is greater than 1500 patients.

Patients admitted to the chest pain unit are provided with all of the diagnostic and management capabilities available to inpatients, but with much more expedient testing. Such testing includes nuclear stress testing, stress echocardiograms, exercise stress tests, coronary CTA, and even occasional catheterization.

All patients admitted to the chest pain unit are evaluated by an emergency physician and mid-level provider. Serial cardiac biomarkers and electrocardiograms are part of a protocol of observation that often results in cardiology consultation. The CPU team tailors the need for further workup to the individual patient.