Rapid point-of-care testing for cardiac markers and BNP reduced time to discharge for ED chest pain patients from 3.6 to 2.3 hours and CCU CHF length of stay from 5.2 to 3.2 days.
Observational (n=4,200)
No
Does point-of-care testing for cardiac markers and BNP reduce length of stay and improve operational efficiency in emergency department patients with suspected ACS or CHF?
Point-of-care testing for cardiac markers and BNP in the emergency department significantly reduces length of stay and improves operational efficiency for patients with suspected ACS and CHF.
Absolute Event Rate: 2.3% vs 3.6%
These days, the timely and accurate diagnosis of acute coronary syndromes (ACSs) and congestive heart failure (CHF) in the emergency department (ED) requires the 24/7 availability of real-time, rapid (≤30 minutes) testing for cardiac markers and B-natriuretic peptide (BNP). We have observed that the rapid availability of laboratory evidence of ACS or CHF, due in part to point-of-care (POC) testing for cardiac markers, has greatly facilitated the diagnosis and management of our cardiac patients. Tangible benefits to our hospitals of rapid POC cardiac marker and BNP testing are clearly in three areas: clinical outcomes improvement, operational improvements (especially in the ED and coronary care unit CCU), and economic benefits. To date, these benefits observed at our institution include a reduction in as much as 15 hours ED length of stay (LOS) /wait time for ACS workup of non-ST-segment elevation acute myocardial infarction patients to a consistent ED LOS of no more than 8 hours. With use of a rapid 0- to 2-hour POC testing protocol, the time to discharge for ED chest pain patients from our chest pain decision unit was reduced from 3. 6 to 2. 3 hours. In addition, our inpatient LOS for CCU CHF patients has been dramatically reduced from 5. 2 to 3. 2 days, a potential savings of over 1000 per day per patient. Since implementation, we have evaluated approximately 4200 patients with chest pain annually (7% of our 60, 000 total ED encounters per year), with no reported inappropriate discharge-to-home events. In addition, our studies indicate rapid BNP measurements are very useful in evaluation of our ED ACS patients as candidates for possible emergency percutaneous cardiac interventions or coronary artery bypass graft interventions.
Kenneth E. Blick (Tue,) conducted a observational in Acute coronary syndromes (ACS) and congestive heart failure (CHF) (n=4,200). Point-of-care (POC) testing for cardiac markers and BNP vs. Pre-implementation standard of care was evaluated on Time to discharge for ED chest pain patients (hours). Rapid point-of-care testing for cardiac markers and BNP reduced time to discharge for ED chest pain patients from 3.6 to 2.3 hours and CCU CHF length of stay from 5.2 to 3.2 days.