Background: Standard practice for patients requiring hospital admission with suspected acute coronary syndromes (ACS) is admission to a monitored cardiology bed. The Western Hospital Chest Pain Protocol was developed to identify a subset of these patients who could be safely managed in an unmonitored bed. Aim: The objective of this prospective study of chest pain patients classified as ‘high’ or ‘intermediate’ risk by the Agency for Health Care Policy and Research/National Health and Medical Research Council guidelines was to further evaluate the safety of this protocol. Methods: This study was a prospective, observational, cohort study investigating the outcomes of patients admitted to hospital with suspected ACS. The primary outcome of interest was death or life-threatening arrhythmia within 24 h of hospital admission.
Results: If the Western Hospital Chest Pain Protocol had been strictly applied, there would have been one death in the group assigned to unmonitored beds (1/750; 0.13%, 95% confidence interval 0.01−0.85%) and no other life-threatening arrhythmias. Conclusion: There is a subgroup of patients with suspected ACS who require hospital admission who can, based on clinical and biochemical features in the emergency department, be safely assigned to unmonitored beds.