Dr Masayuki Shiozaki
Department of Cardiology
Juntendo University Nerima Hospital
Tokyo, Japan
Since joining the cardiology department, I have had difficulties treating patients suspected of having NSTEMI since very little signs show in their electrocardiograms. Our patient management program used to make assessments based on a variety of factors including questionnaires, physical observations, serology, electrocardiograms, X-rays, and other general exams. The life-threatening nature of this disease put us in a very stressful situation with possible legal liability and where we could put the patient at risk as well. We decided on whether to send patients home only after consulting with more senior members of the team. This happened even in the middle of the night. This 0/1h algorithm allowed us to stratify the patients suspected as having AMI in the ER, thereby providing us with a certain basis for making assessments for each case.
The implementation of the 0/1h algorithm was successful in significantly reducing the number of emergency catheterization exams based on unfounded concerns. This allowed us to have more free space in terms of hospital beds and improved the quality of care in the hospital.
Dr Suguru Asako
Department of Emergency Intensive Care
Juntendo University Nerima Hospital
Tokyo, Japan
Due to the nature of our hospital, we occasionally have cases where an ER Doctor has to make an initial assessment of a chest pain patient. Although we cannot afford to misdiagnose potential NSTEMI patients, ER doctors feel somewhat hesitant transferring patients to cardiologists without a solid basis for doing so. This is true, especially during night shifts. The biggest benefit of the 0/1h algorithm is that it provides an objective and absolute index to ER doctors, who are obligated to transfer patients with “chest pain” to cardiologists when they find a reasonable suspicion of ACS. For that, this objective and absolute index carry great significance. Whether for young, inexperienced residents or experienced physicians, this index is constant. There is no doubt this algorithm, which allows us to seek consultation from cardiologists to make correct assessments without personal bias, is valuable. It is also beneficial to the patient. The algorithm also provides a helpful flowchart that gives guidance to follow-up on the patients who were sent home after accordingly receiving an assessment result of “rule out” or “observe”. This follow-up guide reduces the concerns of ER doctors after letting those patients go home.
