Point-of-Care Testing Reduces Length of Stay in Emergency Department Chest Pain Patients
Department of Emergency Medicine, Stony Brook University, Stony Brook, NY 11794, USA. Annals of emergency medicine
(Impact Factor: 4.68).
07/2005; 45(6):587-91. DOI: 10.1016/j.annemergmed.2004.11.020
We determine the effect of cardiac troponin I point-of-care testing on emergency department (ED) length of stay in chest pain patients.
This was a before-and-after trial in a university-based ED with 75,000 annual visits. Participants were consecutive patients with a chief complaint of chest pain who were admitted to the hospital. During the first 2-week period (before), only central laboratory testing of troponin was performed. During the second 2-week period (after), treating nurses performed bedside point-of-care testing for troponin I, as well as central laboratory testing. Test turnaround times, time from triage until calling in admissions, and time from triage until patients left the ED to be transferred to a floor (ED length of stay) were determined and compared between the 2 study periods. Comparisons between study periods are expressed as mean differences with 95% confidence intervals (CIs). A sample of 100 patients in each group had 90% power to detect a 1-hour difference in length of stay (2-tailed alpha=0.05).
There were 232 patients before and 134 after introduction of point-of-care testing. Mean age (SD) was 63 years (16 years), and 44% were female patients. Baseline characteristics were similar in both groups. The rate of positive troponins was also similar (9.5% versus 6.1%). ED length of stay was significantly reduced after introduction of point-of-care testing (5.2 hours [95% CI 4.6 to 5.8 hours] versus 7.1 hours [95% CI 6.6 to 7.7 hours]; mean difference 1.9 hours [95% CI 1.1 to 2.7 hours]). The time until the admission was called in to bed control was also significantly reduced by introducing point-of-care testing (2.7 hours [95% CI 2.4 to 3.1 hours] versus 4.7 hours [95% CI 4.3 to 5.0 hours]; mean difference 1.9 hours [95% CI 1.4 to 2.5 hours]). Point-of-care testing turnaround (14.8 minutes [95% CI 14.1 to 15.5 minutes]) was significantly shorter than for central laboratory testing (83 minutes [95% CI 77 to 89 minutes]; mean difference 68 minutes [95% CI 62 minutes to 74 minutes]). With central testing as the criterion standard, point-of-care testing had a sensitivity of 100% (95% CI 63% to 100%) and a specificity of 96% (95% CI 92% to 99%).
Bedside performance of troponin I point-of-care testing by treating nurses significantly reduces ED length of stay.
Available from: Danielle Lazar
- "Studies have demonstrated the utility of POC testing to aid in shorter lengths of stays. For example, after implementing troponin POC testing in patients with chest pain, the average length of stay decreased by 1.9 hours . "
Available from: Jeffrey M Schussler
- "In an attempt to differentiate truly ischemic cardiac pain from nonischemic pain, many strategies have been tested in an ED setting. These have included (alone or in combination ) electrocardiography (ECG) , cardiac enzymes    , treadmill testing , stress echocardiography , nuclear perfusion   , and even computer-aided algorithms that aid in decision making . However, the bperfectQ test still seems to elude us . "
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ABSTRACT: Sixty-four-slice computed tomographic (CT) coronary angiography is a new technique for the noninvasive visualization of the coronary arteries. It enables noninvasive detection of coronary plaque and determination of severity without instrumentation of the heart. Although not yet commonly used in the emergency department setting, it stands poised to dramatically change the way that patients with chest pain are evaluated. In addition to evaluation of the coronary arteries, CT angiography has long been used to evaluate patients for other dangerous causes of chest pain such as aortic dissection and pulmonary embolus. Although these new scanners excel at all of these diagnostic modalities, the true excitement is in the possibility of combining several different protocols into one, allowing for multiple causes of chest pain to be "ruled out" simultaneously. This article describes the current state of the art of cardiac CT, current state of research, and current areas of controversy.
Available from: Zhen Yang
- "The results of a prospective randomized controlled trial of POCT vs. CLT for cTnT  have revealed that POC testing yielded a reduction not only in the TAT for the tests but also in the time for patients' CCU (Coronary Care Unit) stay and hospital stay. Singer et al.  have also reported a significant reduction in ED length of stay from 7.1 to 5.2 h after introduction of POCT. This can be attributed to the shortening of the analytical period and also the elimination of the majority of pre-and post-analytical delays (such as sample transport, centrifugation, and data processing ) due to the use of POC testing. "
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ABSTRACT: Acute myocardial infarction (AMI) is the world's leading cause of mortality and morbidity. Therefore, quick and reliable diagnostics of AMI is extremely critical. Compared to the traditionally used central laboratory tests (CLT), which can be time-consuming and expensive, point-of-care testing (POCT) for AMI-indicative cardiac markers provides a convenient means for rapid diagnostic assays to be performed at the site of patient care delivery. In this article, the etiology and diagnosis of AMI are introduced, and some typical cardiac markers and their clinical applications are reviewed. Furthermore, the various POC cardiac marker devices that are currently available, the benefits of using cardiac marker POC assays, and challenges that cardiac marker POCT are facing are also discussed.
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