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Chest pain checked at Waynesboro, Pa., hospital

August 14, 2000

Chest pain checked at Waynesboro, Pa., hospital



By RICHARD F. BELISLE / Staff Writer, Waynesboro

photo: RIC DUGAN / staff photographer

Dr. Bruce FosterWAYNESBORO, Pa. - Each year about 800 of the approximately 1,000 people taken to the Waynesboro Hospital Emergency Room with chest pains are sent home because their pains are not heart-related, the hospital's director of emergency medicine said Monday.

Dr. Bruce Foster said it's obvious, after electrocardiogram and other tests are done, that the chest pains of 40 of the 200 remaining patients were caused by heart attacks. Those patients are transferred to the hospital's coronary care unit for intensive care.

It's the remaining 160 patients whose heart damage doesn't show up on EKG and blood enzyme tests until hours later that worry doctors, Foster said. That's where the Chest Pain Evaluation Center, a specially equipped room off the emergency room, is put to use.

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"There may be suspicions, but actual evidence of a heart attack may not show up on an EKG in 10 to 15 percent of the chest pain cases for at least six hours," Foster said.

As a safeguard, before the Chest Pain Evaluation Center - or CPEC as Foster likes to call it - was installed in a room off the emergency room in 1993, such patients were sent to the coronary care unit for 24 hours of intense, invasive and costly tests.

It is an anxious time for patients and their loved ones while their doctors wait for test results that decide the seriousness of their conditions, he said.

By contrast, patients spend just nine hours in the CPEC in a much more relaxed setting. The center's equipment includes a bed, heart-monitoring equipment, a reclining chair and a television. Patients spend their nine hours in the bed or sitting in the chair, often with a loved one by their side. Wires attached to them monitor their conditions while they watch television, read, sleep or visit with their family, Foster said.

The tests over the nine hours show whether the chest pains were caused by heart damage or an unrelated cause such as chest muscle spasms, simple indigestion "or a zillion other causes," Foster said. "If everything is negative after nine hours we can feel really comfortable that the patient did not have a heart attack."

Foster said on average 10 of the 160 patients sent to the CPEC show up with heart damage during the nine hours of monitoring. The other 150 who complained of chest pains get to go home, free of heart problems, at least for now. As things turned out they didn't need to be in the hospital at all, but neither they nor their doctors could know that until the tests were done in the CPEC, Foster said.

According to Sheran White, spokeswoman for Summit Health, which owns Waynesboro and Chambersburg hospitals, Waynesboro's center is the only one of its kind in the Tri-State area.

Mostly Foster's brainchild, the unit was set up in 1993 after he learned that such facilities were operating successfully in other hospitals.

"It made sense to me," Foster said. "It's more of a system of care and how we're organized to provide it."

"All hospitals have their strong points," Foster said. "We don't see much trauma in our emergency room. We see a lot more medical emergencies rather than the kind of surgical emergencies they see in the hospitals in Washington County or Chambersburg That's why we have such a strong cardiac interest here."

Waynesboro Hospital draws patients from Southern Franklin County, northern Washington County and northwest Frederick County, Md., Foster said.

Foster's background is in internal medicine and cardiology.

Waynesboro began making changes in the way it deals with heart patients as far back as the late 1980s, Foster said.

The hospital started with a pilot program that trained paramedics and nurses in how to distinguish between heart attacks and chest pains in the field. As a result of the training, emergency room personnel were better prepared for incoming heart patients, he said.

The second major change was the establishment of CPEC seven years ago, he said.

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