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Shared Decision Making - Chest Pain

Marc Probst MD and Anand Swaminathan, MD FAAEM
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11:20
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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02:31

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EMRAP 2019 03 March Written Summary 434 KB - PDF

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Jim J. -

The shared decision making for low risk chest pain sounds great in theory. In practice however, it can be a bit more complicated. If the patient wants to be admitted (after discussion of options) then I somehow have to sell this to the hospitalist. At my shop, the hospitalist will simply refuse to admit the patient with low risk chest pain because they are LOW RISK. If I offer admission as a portion of the shared decision making, then get shot down by the hospitalist I've just put myself in a bad situation.

Just my 2 cents.

Anand S., M.D. -

Jim - this is a great point: you can only offer what can actually be done. If I offer admission/observation, I make sure it's one that I can convince/sell to my colleagues as being necessary but, this can clearly be quite tricky.

Marc P. -

Yes. Totally agree. Shared decision-making is very context dependent — you can only offer options that are feasible within your system. When I worked at Kaiser, all low risk chest pain patients were discharged from the ED with next day follow-up. Where I currently work, we run the observation unit, so sending a patient to obs overnight for stress test in AM is almost too easy. Chest pain is only one scenario. There are many acute diagnoses where shared decision-making around disposition can be appropriate.

Anand S., M.D. -

Regarding the March Shared Decision Making for CP there was commentary regarding whether something like this could work in a community setting. It can! We studied this at our community hospital and used the HEART Score. Happy to provide more info if needed
-Susy DeMeester

1: Gafni-Pappas G, DeMeester SD, Boyd MA, Ganti A, Nicholson AM, Albright J, Wu
J. The HAS-Choice study: Utilizing the HEART score, an ADP, and shared
decision-making to decrease admissions in chest pain patients. Am J Emerg Med.
2018 Oct;36(10):1825-1831. doi: 10.1016/j.ajem.2018.02.005. Epub 2018 Feb 8.
PubMed PMID: 29454508.

Marc P. -

Very interesting study! Thanks for sharing.

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EM:RAP 2019 March Full episode audio for MD edition 207:41 min - 289 MB - M4AEM:RAP 2019 March German Edition Deutsche 90:57 min - 125 MB - MP3EM:RAP 2019 March Aussie Edition Australian 34:56 min - 48 MB - MP3EM:RAP 2019 March Farsi Edition Farsi 64:12 min - 88 MB - MP3EM:RAP 2019 March French Edition Français 22:38 min - 31 MB - MP3EM:RAP 2019 March Spanish Edition Español 78:59 min - 108 MB - MP3EM:RAP 2019 March Canadian Edition Canadian 18:22 min - 25 MB - MP3EMRAP_2019 03 March Board Review Answers_V2 135 KB - PDFEMRAP_2019 03 March Board Review Questions_V2 96 KB - PDFEMRAP 2019 03 March Individual MP3 229 MB - ZIPEMRAP_2019_03_March_Individual_Written 601 KB - ZIPEMRAP 2019 03 March Spanish Written 1 MB - PDFEMRAP 2019 03 March Written Summary 434 KB - PDF

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