2.50
Hdl Handle:
http://hdl.handle.net/10755/162700
Type:
Presentation
Title:
The Impact of Implementing Cardiac Multi-Markers at the Point-of-Care
Abstract:
The Impact of Implementing Cardiac Multi-Markers at the Point-of-Care
Conference Sponsor:Emergency Nurses Association
Conference Year:2008
Author:Haddix-Hill, Katherine, RN, MSN
P.I. Institution Name:Moses Cone Health Care System
Title:Executive Director of Emergency Services
Contact Address:, Greensboro, NC, 27401-, USA
Contact Telephone:(336) 832-8799
Purpose: The purpose of this study was to evaluate the clinical, economic and operational impact of implementing a cardiac multi-marker approach at the point-of-care in the ED.

Design: Product Value Analysis

Setting: This study involved two community hospitals within a healthcare system located in the southeast. Hospital A is a 535-bed hospital housing a Level II Trauma Center and recently accredited Stroke Center. Hospital B is a 110 bed community hospital, and a sister facility to Hospital A.

Participants/Subjects: All patients presenting with chest pain and meeting the criteria listed in the protocol.

Methods: Each hospital implemented Cardiac Multi-Marker Point-of-Care (POC) Testing in the ED. Hospital A implemented in July 2004. Hospital B implemented in May of 2005. POC testing of cardiac multi-markers was implemented to decrease lab turn-around-time and to provide timely patient information to support appropriate disposition of patients experiencing chest pain. Nursing staff performed the testing and alerted the physicians to abnormal results. Myoglobin, CK-MB and Troponin I assays were performed with the Biosite Triage system (Biosite, San Diego, CA) using a 0, 2 and 4 hour protocol.
Electronic patient data was collected from the EMSTAT Information System and the IDX Patient Information System for six months pre-implementation and six months post-implementation. Outcomes metrics were calculated and all results were annualized.
The metrics studied include: 1) Number of chest pain patients evaluated in the ED, admitted as inpatients and subsequently discharged with non-specific chest pain (DRG 143); 2) Number of patients discharged home directly from the ED; and 3) ED time to disposition decision for all patients presenting with chest pain.

Results: Hospital A and B experienced a 14% and 37% decrease in DRG 143 discharges respectively. Both hospitals also increased the number of patients discharged home from the ED. The time to disposition decision increased at both facilities, however this was considered a desirable tradeoff when considering the improvement in patient disposition and reduction in unnecessary admissions. Focusing on this, an economic impact of $251,116 was calculated based on decreased costs for patient days saved and increased ED reimbursement.

Recommendations:

1. Continue POC services in the ED while continuously monitoring clinical, economic and operational impact.
2. Evaluate additional variables/processes contributing to ED LOS
3. Explore opening a Chest Pain Center within the ED to expedite movement of chest pain patients through the ED.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleThe Impact of Implementing Cardiac Multi-Markers at the Point-of-Careen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162700-
dc.description.abstract<table><tr><td colspan="2" class="item-title">The Impact of Implementing Cardiac Multi-Markers at the Point-of-Care</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2008</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Haddix-Hill, Katherine, RN, MSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Moses Cone Health Care System</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Executive Director of Emergency Services</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">, Greensboro, NC, 27401-, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(336) 832-8799</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">Katherine.haddixhill@mosescone.com</td></tr><tr><td colspan="2" class="item-abstract">Purpose: The purpose of this study was to evaluate the clinical, economic and operational impact of implementing a cardiac multi-marker approach at the point-of-care in the ED. <br/><br/>Design: Product Value Analysis<br/><br/>Setting: This study involved two community hospitals within a healthcare system located in the southeast. Hospital A is a 535-bed hospital housing a Level II Trauma Center and recently accredited Stroke Center. Hospital B is a 110 bed community hospital, and a sister facility to Hospital A.<br/><br/>Participants/Subjects: All patients presenting with chest pain and meeting the criteria listed in the protocol. <br/><br/>Methods: Each hospital implemented Cardiac Multi-Marker Point-of-Care (POC) Testing in the ED. Hospital A implemented in July 2004. Hospital B implemented in May of 2005. POC testing of cardiac multi-markers was implemented to decrease lab turn-around-time and to provide timely patient information to support appropriate disposition of patients experiencing chest pain. Nursing staff performed the testing and alerted the physicians to abnormal results. Myoglobin, CK-MB and Troponin I assays were performed with the Biosite Triage system (Biosite, San Diego, CA) using a 0, 2 and 4 hour protocol. <br/>Electronic patient data was collected from the EMSTAT Information System and the IDX Patient Information System for six months pre-implementation and six months post-implementation. Outcomes metrics were calculated and all results were annualized.<br/>The metrics studied include: 1) Number of chest pain patients evaluated in the ED, admitted as inpatients and subsequently discharged with non-specific chest pain (DRG 143); 2) Number of patients discharged home directly from the ED; and 3) ED time to disposition decision for all patients presenting with chest pain.<br/><br/>Results: Hospital A and B experienced a 14% and 37% decrease in DRG 143 discharges respectively. Both hospitals also increased the number of patients discharged home from the ED. The time to disposition decision increased at both facilities, however this was considered a desirable tradeoff when considering the improvement in patient disposition and reduction in unnecessary admissions. Focusing on this, an economic impact of $251,116 was calculated based on decreased costs for patient days saved and increased ED reimbursement. <br/><br/>Recommendations: <br/><br/>1. Continue POC services in the ED while continuously monitoring clinical, economic and operational impact.<br/>2. Evaluate additional variables/processes contributing to ED LOS<br/>3. Explore opening a Chest Pain Center within the ED to expedite movement of chest pain patients through the ED.</td></tr></table>en_GB
dc.date.available2011-10-27T10:32:39Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:32:39Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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