Kathryn R Crowder1, Tristan D Jones2, Eddy S Lang1, Dongmei M Wang1, Steven M Clark1, Grant D Innes1, James D McMeekin1, Michelle M Graham3, Andrew D McRae4. 1. University of Calgary, Foothills Campus, 3330 Hospital Dr NW, Calgary, AB, Canada T2N 4N1; Alberta Health Services, Foothills Medical Center 1403-29 St NW, Calgary, AB, Canada T2N 2T9. 2. University of Calgary, Foothills Campus, 3330 Hospital Dr NW, Calgary, AB, Canada T2N 4N1. 3. Alberta Health Services, Foothills Medical Center 1403-29 St NW, Calgary, AB, Canada T2N 2T9; University of Alberta, 8440 112 St NW, Edmonton, AB, Canada T6G 2B7. 4. University of Calgary, Foothills Campus, 3330 Hospital Dr NW, Calgary, AB, Canada T2N 4N1; Alberta Health Services, Foothills Medical Center 1403-29 St NW, Calgary, AB, Canada T2N 2T9. Electronic address: amcrae@ucalgary.ca.
Abstract
OBJECTIVE: High-sensitivity troponin T (hs-TnT) assays detect myocardial injury sooner, possibly improving throughput times for emergency department (ED) assessment of suspected acute myocardial infarction (AMI). This study evaluates the influence of hs-TnT implementation on ED length of stay (LOS), consultations and admissions, as well as ED revisits with cardiology admissions for patients undergoing testing for suspected AMI. METHODS: This control pre-post design analysis included patients evaluated using hs-TnT or conventional troponin T. Data were collected from 3 ED databases for patients who had a troponin assay for suspected AMI for the periods February 12, 2011-April 22, 2011 (Ctrl); November 20, 2011-January 28, 2012 (Pre); and February 12, 2012-April 21, 2012 (Post). The primary outcome was ED LOS; secondary outcomes included the proportions of patients who received ED cardiology consultations, patients who were admitted to hospital, and discharged patients who revisited the ED within 30 days. RESULTS: Data were analyzed from 6650 (Ctrl), 6866 (Pre), and 5754 (Post) patients. Median ED LOS decreased following hs-TnT implementation (6.60 hours in Ctrl and Pre vs 6.10 hours in Post, P < .001). There was no change in cardiology consultations or admissions following hs-TnT implementation. Fewer ED revisits occurred within 30 days in Post (16.0% Ctrl, 16.5% Pre vs 14.9% Post; P < .01). These results were preserved after adjusting for age and Canadian Triage Acuity Score. CONCLUSIONS: This hs-TnT implementation strategy, using an equivalent cutoff for the conventional troponin T and hs-TnT assays, decreased ED LOS for patients with suspected AMI and did not increase cardiology resource utilization or ED revisits.
OBJECTIVE: High-sensitivity troponin T (hs-TnT) assays detect myocardial injury sooner, possibly improving throughput times for emergency department (ED) assessment of suspected acute myocardial infarction (AMI). This study evaluates the influence of hs-TnT implementation on ED length of stay (LOS), consultations and admissions, as well as ED revisits with cardiology admissions for patients undergoing testing for suspected AMI. METHODS: This control pre-post design analysis included patients evaluated using hs-TnT or conventional troponin T. Data were collected from 3 ED databases for patients who had a troponin assay for suspected AMI for the periods February 12, 2011-April 22, 2011 (Ctrl); November 20, 2011-January 28, 2012 (Pre); and February 12, 2012-April 21, 2012 (Post). The primary outcome was ED LOS; secondary outcomes included the proportions of patients who received ED cardiology consultations, patients who were admitted to hospital, and discharged patients who revisited the ED within 30 days. RESULTS: Data were analyzed from 6650 (Ctrl), 6866 (Pre), and 5754 (Post) patients. Median ED LOS decreased following hs-TnT implementation (6.60 hours in Ctrl and Pre vs 6.10 hours in Post, P < .001). There was no change in cardiology consultations or admissions following hs-TnT implementation. Fewer ED revisits occurred within 30 days in Post (16.0% Ctrl, 16.5% Pre vs 14.9% Post; P < .01). These results were preserved after adjusting for age and Canadian Triage Acuity Score. CONCLUSIONS: This hs-TnT implementation strategy, using an equivalent cutoff for the conventional troponin T and hs-TnT assays, decreased ED LOS for patients with suspected AMI and did not increase cardiology resource utilization or ED revisits.
Authors: Nicholas J Bevins; Hyojin Chae; Jacqueline A Hubbard; Edward M Castillo; Vaishal M Tolia; Lori B Daniels; Robert L Fitzgerald Journal: Am J Clin Pathol Date: 2022-05-04 Impact factor: 5.400
Authors: Bryn E Mumma; Scott D Casey; Robert K Dang; Michelle K Polen; Jasmanpreet C Kaur; John Rodrigo; Daniel J Tancredi; Robert A Narverud; Ezra A Amsterdam; Nam Tran Journal: Ann Emerg Med Date: 2020-08-15 Impact factor: 5.721
Authors: Andrew D McRae; Grant Innes; Michelle Graham; Eddy Lang; James E Andruchow; Yunqi Ji; Shabnam Vatanpour; Tasnima Abedin; Hong Yang; Danielle A Southern; Dongmei Wang; Isolde Seiden-Long; Lawrence DeKoning; Peter Kavsak Journal: Acad Emerg Med Date: 2017-08-11 Impact factor: 3.451