The Clinical Investigation and Management of Chest Pain in an Emergency Department

Criteria Mapping, a recently developed chart review method, was tested for its ability to assess the quality of symptom investigation and management for the presenting complaint of chest pain in an emergency department. A criteria map, which is based on decision making logic and permits use of criteria relevant to individual patients, was used to review the records of 137 patients who were examined for chest pain and subsequently discharged from the emergency department. All 111 patients assessed as receiving adequate process had positive outcomes. Twenty-six charts (19 per cent) were determined to have inadequate process, having failed at least one relevant and critical criterion; 23 of these 26 patients had positive outcomes. Review of the unmet criteria in these 23 charts revealed their uncertain predictive validity regarding immediate risk of death. We conclude that the Criteria Mapping method--the first reported technique for evaluating care for patient problems (as opposed to diagnoses)--provides an effective and feasible means for assessing the quality of symptom investigation and management.