This article has three things I like - information graphics, informed patients, and an attempt to reduce low-yield chest pain admissions. Unfortunately, in the end, I'm not sure about the strategy.
This is a prospective study in which the authors developed an information graphic attempting to illustrate the outcome risks for low-risk chest pain presentations. They use this information graphic as the intervention in their study population to help educate patients regarding the decision whether to be observed in the hospital with potential provocative stress testing, or whether they would like to be discharged from the Emergency Department to follow-up for an outpatient provocative test. They were attempting to show that use of this decision aid would lead to increased patient knowledge and satisfaction, as well as reduce observation admissions for low-risk chest pain.
The good news: it definitely works. Patients reported increased knowledge, most were happy with the decision instrument, and a significantly increased proportion elected to be discharged from the Emergency Department - 58% of the decision aid group wanted to stay vs. 77% of the "usual care" arm wanted to stay.
My only problem: this study truly exposes the invalidity of our current management of chest pain. If these patients are low-risk and they're judged safe enough for the outpatient strategy in this study – why are any of them being offered admission? Of course, it's probably because they don't have timely follow-up, and AHA guidelines dictate stress testing urgently following the index visit. But, truly, in an ideal world, few (if any) of these low-risk patients – such as the one who ruled in by enzymes – should be offered admission.
But, other than that, I'm all for information graphics and patient education techniques to include them in a shared decision-making process!
"The Chest Pain Choice Decision Aid : A Randomized Trial"