Impact of a Rapid High-Sensitivity Troponin Pathway on Patient Flow in an Urban Emergency Department
Publication Date
6-1-2022
Journal
Journal of the American College of Emergency Physicians Open
DOI
10.1002/emp2.12739
PMID
35571147
PMCID
PMC9071237
PubMedCentral® Posted Date
5-5-2022
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
: acute coronary syndrome, high‐sensitivity cardiac troponin, length of stay, myocardial infarction, throughput, troponin
Abstract
STUDY OBJECTIVE: To evaluate whether the introduction of a 1-hour high-sensitivity cardiac troponin-T (hs-TnT) pathway for patients who present to the emergency department (ED) with suspected acute coronary syndrome (ACS) improves ED patient flow without changing the rate of "missed" major adverse cardiac events (MACE), compared to use of conventional cardiac troponin with an associated 3-hour pathway.
METHODS: This was a prospective, uncontrolled observational study conducted before and after implementation of a 1-hour hs-TnT pathway at a high-volume urban ED. Patients undergoing evaluation for ACS in the ED were enrolled during their initial visit and clinical outcomes were assessed at 30 and 90 days. Throughput markers were extracted from the electronic medical record and compared. The primary outcome was provider-to-disposition decision time.
RESULTS: A total of 1892 patients were enrolled, 1071 patients while using conventional troponin and 821 after introduction of hs-TnT. With the new assay and pathway, median interval between troponin tests decreased from 4.7 hours (interquartile range [IQR] 3.9-5.7 hours) to 2.3 hours (IQR 1.5-3.4 hours) (
CONCLUSION: Introduction of a 1-hour hs-TnT ACS evaluation pathway reduced the troponin collection interval but did not reduce provider to disposition time. There was no difference in rate of 30-day MACE in patients discharged from the ED.
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Cardiology Commons, Cardiovascular Diseases Commons, Emergency Medicine Commons, Medical Sciences Commons
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