Effect on emergency department efficiency of an accelerated diagnostic pathway for the evaluation of chest pain

Abstract

Objective: To compare ED efficiency measures between a trial period using an accelerated diagnostic pathway (ADP) for chest pain evaluation, and a control period using a traditional diagnostic pathway (TDP).

Methods: The TDP used cardiac Troponin I assays at arrival and 6 h. The ADP used point-of-care multimarker (myoglobin, creatine kinase-MB fraction and cardiac Troponin I) assays at arrival and 2 h. Outcomes for consecutive eligible patients included ED length of stay (LOS), discharges and admissions within 4 and 8 h, ED occupancy and cardiac cubicle throughput.

Results: There were 413 and 258 eligible patients during the 81 day TDP and 66 day ADP periods. The ED LOS for chest pain patients was reduced in the ADP period for both discharged patients (median 297 [interquartile range {IQR} 230-437]vs 545 [IQR 457-677] min, P < 0.0001) and admitted patients (median 609.5 [IQR 464-857]vs 733.5 [IQR 532-1070] min, P= 0.007). For the whole ED, the percentage of patients discharged or admitted within 4 or 8 h and ED occupancy were similar between periods. Cardiac cubicle throughput increased during the ADP period (217 [95% confidence interval 209.6-224.4]vs 188 [95% confidence interval 174.5-201.8] patients per week, P= 0.005).

Conclusions: The ADP utilizing point-of-care multimarkers led to significantly shorter ED LOS for both discharged and admitted chest pain patients. This was associated with increased cardiac cubicle throughput, but improvements in other whole ED performance indicators were not demonstrated.