TY - JOUR
T1 - Implementation of high-sensitivity troponin with a rapid diagnostic algorithm reduces emergency department length of stay for discharged patients
AU - Hughes, Andrew E.O.
AU - Forbriger, Arthur
AU - May, Adam M.
AU - Scott, Mitchell
AU - Char, Douglas
AU - Farnsworth, Christopher W.
N1 - Publisher Copyright:
© 2023 The Canadian Society of Clinical Chemists
PY - 2023/6
Y1 - 2023/6
N2 - Introduction: High sensitivity troponin (hs-cTn) and diagnostic algorithms are used to rapidly triage patients with symptoms of acute myocardial infarction in emergency departments (ED). However, few studies have evaluated the impact of simultaneously implementing hs-cTn and a rapid rule-out algorithm on length of stay (LOS). Methods: We assessed the impact of transitioning from contemporary cTnI to hs-cTnI in 59,232 ED encounters over three years. hs-cTnI was implemented with an orderable series that included baseline, two-, four-, and six-hour specimens collected at provider discretion and operationalized with an algorithm to calculate the change in hs-cTnI from baseline and provide interpretations of “insignificant”, “significant,” or “equivocal.” Patient demographics, results, chief complaint, disposition, and ED LOS were captured from the electronic medical record. Results: cTnI was ordered for 31,875 encounters prior to hs-cTnI implementation and 27,357 after. The proportion of cTnI results above the 99th percentile upper reference limit decreased from 35.0% to 27.0% for men and increased from 27.8% to 34.8% for women. Among discharged patients, the median LOS decreased by 0.6 h (0.5–0.7). LOS among discharged patients with a chief complaint of chest pain decreased by 1.0 h (0.8–1.1) and further decreased by 1.2 h (1.0–1.3) if the initial hs-cTnI was below the limit of quantitation. The rate of acute coronary syndrome upon re-presentation within 30 days did not change post-implementation (0.10% versus 0.07%). Conclusion: Implementation of an hs-cTnI assay with a rapid rule-out algorithm decreased ED LOS among discharged patients, particularly among those with a chief complaint of chest pain.
AB - Introduction: High sensitivity troponin (hs-cTn) and diagnostic algorithms are used to rapidly triage patients with symptoms of acute myocardial infarction in emergency departments (ED). However, few studies have evaluated the impact of simultaneously implementing hs-cTn and a rapid rule-out algorithm on length of stay (LOS). Methods: We assessed the impact of transitioning from contemporary cTnI to hs-cTnI in 59,232 ED encounters over three years. hs-cTnI was implemented with an orderable series that included baseline, two-, four-, and six-hour specimens collected at provider discretion and operationalized with an algorithm to calculate the change in hs-cTnI from baseline and provide interpretations of “insignificant”, “significant,” or “equivocal.” Patient demographics, results, chief complaint, disposition, and ED LOS were captured from the electronic medical record. Results: cTnI was ordered for 31,875 encounters prior to hs-cTnI implementation and 27,357 after. The proportion of cTnI results above the 99th percentile upper reference limit decreased from 35.0% to 27.0% for men and increased from 27.8% to 34.8% for women. Among discharged patients, the median LOS decreased by 0.6 h (0.5–0.7). LOS among discharged patients with a chief complaint of chest pain decreased by 1.0 h (0.8–1.1) and further decreased by 1.2 h (1.0–1.3) if the initial hs-cTnI was below the limit of quantitation. The rate of acute coronary syndrome upon re-presentation within 30 days did not change post-implementation (0.10% versus 0.07%). Conclusion: Implementation of an hs-cTnI assay with a rapid rule-out algorithm decreased ED LOS among discharged patients, particularly among those with a chief complaint of chest pain.
UR - http://www.scopus.com/inward/record.url?scp=85152558865&partnerID=8YFLogxK
U2 - 10.1016/j.clinbiochem.2023.04.003
DO - 10.1016/j.clinbiochem.2023.04.003
M3 - Article
C2 - 37054770
AN - SCOPUS:85152558865
SN - 0009-9120
VL - 116
SP - 87
EP - 93
JO - Clinical Biochemistry
JF - Clinical Biochemistry
ER -