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Health Services and Economic Impacts of the Limit of Detection in Emergency Department (LEGEND) Rule‐Out Strategy in Australian Emergency Departments: A Stepped‐Wedge Cluster Randomised Trial

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Stepped-wedge cluster randomised trial shows reduced costs and resource use in emergency department ACS assessment.

The LEGEND strategy reduced mean ED length of stay by 72 minutes and inpatient admissions by 2.3%.
Total costs per patient dropped from $6849 to $5794, saving $1055 overall in healthcare costs.
For low-risk patients, the strategy further improved outcomes with a 97-minute reduction in ED stay and 4.2% fewer admissions.
Exercise stress testing decreased by 3.6% overall and 7.7% in low-risk patients during the intervention phase.

Dobson et al. (2025) studied this question.

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