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Improving patient flow in acute coronary syndromes in the face of hospital crowding
Robert H Birkhahn1, Wendy Wen, Paris A Datillo
1Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
Insights
Point-of-care cardiac biomarker testing significantly reduced telemetry admissions and length of stay in the emergency department (ED) and hospital. This rapid testing strategy improved patient flow and reduced overall mortality for acute coronary syndrome (ACS) evaluations.
Area of Science:
- Emergency Medicine
- Cardiology
- Clinical Diagnostics
Background:
- Current emergency department (ED) evaluation for acute coronary syndromes (ACS) focuses on identifying active cardiac disease.
- A majority of patients presenting with suspected ACS do not have underlying cardiac disease.
Purpose of the Study:
- To assess the impact of bedside point-of-care (POC) cardiac biomarker testing on telemetry unit admissions from the ED.
- To evaluate the influence of telemetry admissions on ED and overall hospital length of stay (LOS).
Main Methods:
- Observational cohort study in an urban teaching hospital ED over two 6-month periods (pre- and post-POC implementation).
- Key metrics included telemetry admissions, ED LOS, hospital LOS, patient disposition, and 30-day follow-up for adverse events.
- Utilized a POC testing platform for rapid cardiac biomarker analysis.
Main Results:
- A 30% reduction in telemetry admissions and a 33% decrease in ED LOS were observed post-POC implementation.
- Hospital LOS decreased by 20%, and overall mortality saw a significant 62% reduction (p=0.001).
- Confidence intervals indicated statistically significant improvements across key outcome measures.
Conclusions:
- Rapid cardiac disposition protocols utilizing POC testing can significantly improve resource utilization and patient flow.
- This strategy expedites patient management and enhances short-term outcomes for patients with suspected ACS.
- POC testing demonstrates a powerful impact on efficiency and patient safety in the ED setting.
Background:
The current paradigm for the evaluation of patients with suspected acute coronary syndromes (ACS) in the emergency department (ED) is focused on the identification of patients with active underlying coronary disease. The majority of patients evaluated in the ED setting do not have active underlying cardiac disease.
Objective:
To measure the effect of bedside point-of-care (POC) cardiac biomarker testing on telemetry unit admissions from the ED. Furthermore, to evaluate the effect telemetry admissions have on ED length of stay (LOS) and overall hospital LOS.
Methods:
Primary data were collected over two 6-month periods in an urban teaching hospital ED. This was an observational cohort study conducted pre- and post-availability of a POC testing platform for cardiac biomarkers. Major measures included number of overall telemetry admissions, ED LOS, hospital LOS, and disposition. Patients were followed at 30 days for significant cardiac events, repeat ED visit or admission, and death.
Results:
In the post-implementation period there was a 30% (95% confidence interval [CI] 36-44%) reduction in admissions to telemetry with a 33% (95% CI 26-39%) reduction in ED LOS and a 20% (95% CI 7-34%) reduction in hospital LOS. There was a 62% reduction in overall mortality between the pre-implementation period and the post-implementation period (p=0.001).
Conclusion:
The focused use of a rapid cardiac disposition protocol can dramatically impact resource utilization, expedite patient flow, and improve short-term outcomes for patients with suspected ACS.
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