Costs of an emergency department-based accelerated diagnostic protocol vs hospitalization in patients with chest
R R Roberts1, R J Zalenski, E K Mensah
1Department of Emergency Medicine, Cook County Hospital/Rush University, Chicago, IL 60612, USA. rroberts@rush.edu
Insights
Accelerated diagnostic protocols (ADPs) significantly reduce hospital admissions, length of stay, and costs for low-risk chest pain patients. This ED-based approach offers a more efficient and cost-effective evaluation for potential acute myocardial infarction (AMI).
Area of Science:
- Emergency Medicine
- Cardiology
- Health Economics
Background:
- Over 3 million US patients hospitalized annually for chest pain incur significant costs, particularly those without acute disease.
- Rapid diagnostic tests have led to the development of accelerated diagnostic protocols (ADPs) and chest pain observation units.
- Existing protocols often result in prolonged hospital stays and high expenditures for patients requiring evaluation for acute myocardial infarction (AMI).
Purpose of the Study:
- To evaluate the effectiveness of an emergency department (ED)-based accelerated diagnostic protocol (ADP) in reducing hospital admission rates, total costs, and length of stay (LOS) for chest pain patients.
- To assess the economic impact and resource utilization of ED-based ADPs compared to traditional inpatient evaluations.
- To determine if ADPs can safely manage low-risk chest pain patients, thereby optimizing healthcare resource allocation.
Main Methods:
- A prospective randomized controlled trial was conducted comparing ADP utilization against standard inpatient care for chest pain patients.
- Patients were selected from a large urban public teaching hospital, with a focus on a predominantly African American and Hispanic population.
- A total of 165 patients, identified as low-risk for AMI/ACI using a validated algorithm, were randomized from a larger cohort of 429 patients.
Main Results:
- The hospital admission rate for patients managed with ADP was significantly lower at 45.2% compared to 100% for controls (P<.001).
- Mean total cost per patient was reduced by $567 for the ADP group ($1528) versus the control group ($2095) (P<.001).
- Mean length of stay (LOS) was also reduced for the ADP group (33.1 hours) compared to controls (44.8 hours) (P<.01).
Conclusions:
- ED-based ADPs are effective in decreasing hospitalization rates for low-risk chest pain patients.
- The implementation of ADPs leads to substantial cost savings and reduced length of stay.
- ADPs represent a valuable strategy for efficient and cost-effective evaluation of chest pain in the emergency department, particularly for potential acute myocardial infarction or acute cardiac ischemia.
Context:
More than 3 million patients are hospitalized yearly in the United States for chest pain. The cost is over $3 billion just for those found to be free of acute disease. New rapid diagnostic tests for acute myocardial infarction (AMI) have resulted in the proliferation of accelerated diagnostic protocols (ADPs) and chest pain observation units.
Objective:
To determine whether use of an emergency department (ED)-based ADP can reduce hospital admission rate, total cost, and length of stay (LOS) for patients needing admission for evaluation of chest pain.
Design:
Prospective randomized controlled trial comparing admission rate, total cost, and LOS for patients treated using ADP vs inpatient controls. Total costs were determined using empirically measured resource utilization and microcosting techniques.
Setting:
A large urban public teaching hospital serving a predominantly African American and Hispanic population.
Patients:
A sample of 165 patients was randomly selected from a larger consecutive sample of 429 patients with chest pain concurrently enrolled in an ADP diagnostic cohort trial. Eligible patients presented to the ED with clinical findings suggestive of AMI or acute cardiac ischemia (ACI) but at low risk using a validated predictive algorithm.
Main Outcome Measures:
Primary outcomes measured for each subject were LOS and total cost of treatment.
Results:
The hospital admission rate for ADP vs control patients was 45.2% vs 100% (P<.001). The mean total cost per patient for ADP vs control patients was $1528 vs $2095 (P<.001). The mean LOS measured in hours for ADP vs control patients was 33.1 hours vs 44.8 hours (P<.01).
Conclusions:
In this trial, ADP saved $567 in total hospital costs per patient treated. Use of ED-based ADPs can reduce hospitalization rates, LOS, and total cost for low-risk patients with chest pain needing evaluation for possible AMI or ACI.
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