In-patient transfer for coronary angiography: a substitute for clinical evaluation?

Waiting for in-patient transfer for the investigation of chest pain is a significant cause of ‘bed-blocking’. We performed an audit of 58 consecutive in-patient transfers. The mean delay between referral and transfer was 10 days (range one to 28 days). At the time of transfer the mean number of pain-free days was five (range one to 21 days). Of the 37 patients with a working diagnosis of unstable angina, only 19 (51%) underwent some sort of non-invasive risk stratification prior to referral, nine patients (24%) were walking around the hospital or had taken weekend leave and 13 (35%) had normal anatomy or subcritical disease. Of 21 with post-infarct angina, seven (33%) underwent exercise stress testing, five (24%) were mobilising around the hospital and 18 (86%) underwent some sort of intervention.
In conclusion, waiting times for in-patient angiography were long and utilisation of non-invasive investigation was low.