Concordance between Emergency Physicians and Cardiologists in Emergency Department

Abstract

Objectives: The aim of this study was to evaluate the concordance between emergency physicians and cardiologists in the management of patients with cardiovascular complaints and to determine the efficacy of consultations with cardiologist in the emergency department.
Materials and Methods: This analytic research project was conducted in a tertiary university hospital emergency department and cardiology clinic during a one-month period. 240 adult patients with possible or equivalent signs of acute coronary syndromes or any other indication for a cardiology consultation in the emergency department were included. Relationship between emergency physicians and cardiology consultants in initial diagnosis, mean time to make the appropriate initial diagnosis, making an appropriate management plan, mean time to make an appropriate management plan and appropriate final diagnosis were observed.
Results: Seventy of 195 (35.9%) patients received consultations by the cardiologist. The rate of appropriate cardiology consultation decisions were 92.2% (180/195). Emergency physicians ordered four (2.2%) inappropriate positive and 11 (5.6%) inappropriate negative consultations. Of the patients who were consultated, there was not any significant discordance between emergency physicians and cardiology consultants in inital diagnosis, in mean time to make the appropriate inital diagnosis, in making an appropriate management plan; in mean time to make an appropriate management plan, in appropriate final diagnosis (p=0.125, p=0.50, p=0.063, p=0.063, p=0.063, respectively). Emergency physicians had a significantly higher error rate in management of cases who did not have consultations (p=0.023).
Conclusion: Management of patients with cardiac symptoms by emergency medicine residents is concordant with cardiology consultants in the emergency department.