Thread by @MyaCubitt

There are alarm bells being sounded regarding data on #chestpain presentations in VIC. A 🧵/

Last yr many at the front line, escalated our concerns about massively ⬆️ post #COVID vaccination #chestpain presentations. These were largely benign, extremely rarely not, enormously resource consuming & real & scary for our community who have been taught to fear chest pain. 2/

This resulted in a flurry of guideline writing to try to help improve risk assessment & resource stewardship in a presentation that can mean many things, sometimes completely unrelated to our ❤️’s. 3/

acem.org.au/getmedia/0bb52…

But the reality remains - few of the models of care for healthcare in #VIC offer any options for acute assessment of #chestpain. Hotlines, virtual services, secondary triage systems - will all tell you to present to your nearest ED. Because what if you’re the needle right? 4/

The consequences of missing an important underlying, potentially life threatening pathology, heralded by #chestpain - are a real risk that we all carry when we hear those words. 5/

Queue high profile deaths after #chestpain, in a community more stressed, more overweight, less exercised & likely more alcohol dependent than ever before - & the #chestpain presentations continue to rise. 6/

In the school of “don’t bring me a problem, bring me a solution” - at this point I’m supposed to offer wise advice. But in the real world of complex interdependent, overburdened systems, risk management & community expectation - this problem is bigger than EDs. 7/

There are many more❓than answers such as, is #chestpain really rising, or is it just perception, because #chestpain isn’t amenable to growing diversion at secondary triage & virtual services? What are the numerators & denominators over time & across the system? 8/

How does triage help us with #chestpain? This blunt tool gives every pt w #chestpain a category 2 - must be seen in 10mins. Its not a useful risk assessment & elevates an often benign presentation above many many other complex, urgent presentations. 9/

So what would be better? How are we going to tackle #chestpain? A ❤️ centre I hear - but many who present with #chestpain, have a pathology that has nothing to do with their ❤️. Its an undifferentiated pt grp who need expert risk assessment & frequently diagnostics. 10/

It is only by better understanding the problem, that we will start to arrive at solutions that address more than just the final common destination of an 🚑 to an ED. We will need transparently shared & linked data at all points across the system to help us get there. 11/

This is an opportunity for us to bring all parts of the health system together - so that we can better define the problem facing our communities. This is not a problem throwing resources at one small part of it can solve. 12/

In the meantime, visit your GP &/or regular specialists & get your check ups - because prevention & plans are better than any reactive intervention. And we’re here if you need us. End/