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Use of Emergency Room Predictive Instrument Could Save More than $700 Million Annually

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Press Release Date: November 30, 1998

A new add-on to a standard electrocardiograph, originally developed with funding from the U.S. Agency for Health Care Policy and Research (AHCPR), could help hospitals reduce inappropriate admissions to cardiac care units (CCUs) without lowering the quality of care for patients.

According to the AHCPR-funded study, combining a computer with a traditional instrument—the electrocardiograph—used in emergency departments could prevent 200,000 unnecessary hospitalizations and more than 100,000 admissions to CCUs per year, nationwide. This translates into a savings of roughly $728 million each year in hospital costs, or approximately $100 saved for each of the 6 million to 7 million emergency room visits annually for chest pain. Details appear in the December 1 Annals of Internal Medicine. Harry P. Selker, M.D., of the New England Medical Center and Tufts University School of Medicine, led the researchers/developers of this predictive instrument and the running of the clinical trial.

When using this decision support system, doctors type in the patient's sex, age, and the presence of chest pains, and the instrument computes and prints on the EKG printout, the probability of acute cardiac ischemia, which occurs when there is inadequate blood supply to the heart—a precursor of a heart attack. More informed, emergency room doctors can better decide on hospitalization or discharge and treatment options.

The trial, which included 10,700 patients, found a 15 to 12 percent reduction in admissions to CCUs for patients without cardiac ischemia. For patient with stable angina, the CCU admission rate dropped 26 to 13 percent, and there was a 45 to 56 percent increase in discharges to the home. Appropriately, for patients with acute myocardial infarction (heart attack) and unstable angina, the decision support system did not reduce hospital admissions and treatment.

Editor's Note: For interviews with Dr. Selker, call Julie Sullivan of the New England Medical Center's Division of Clinical Care Research, (617) 636-5009.

For additional information, contact AHCPR Public Affairs: Karen Migdail, (301) 427-1855 (

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