Motherwell D W, Rogers J, Kellagher M, Craig D, O'Reilly D S J, Cobbe S M
Section of Cardiology, Division of Cardiovascular and Medical Sciences, University of Glasgow, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER.
Scott Med J. 2007 May;52(2):6-9. doi: 10.1258/rsmsmj.52.2.6.
Troponin I (TnI) measurement is important in decision making and management of patients who present with chest pain. Undetectable levels of TnI in these patients are associated with a low risk of death or myocardial infarction at 30 days, and may allow early discharge from hospital.
An audit was performed tracking patients who presented with chest pain and had a TnI blood test requested. Routine clinical service was audited for three months. A "fast-track" troponin service and chest pain specialist nurse was then introduced to assist in the management of patients. This was continued for three months to assess the impact on length of stay.
446 patients were admitted during the first three month period and 511 patients admitted during the second monitoring period when the new measures were introduced. The time from chest pain onset until the TnI blood test was taken reduced from 23.0 hours to 20.3 hours. The percentage of patients admitted to hospital wards from the Acute Medical Receiving Unit (AMRU) fell from 62% to 53% (p < 0.001). The new measures resulted in a reduction in admission time from 73.1 hours to 51.0 hours.
A fast-track troponin and specialist nurse achieved a reduction of nearly 24 hours in length of stay in patients presenting with chest pain. This would result in a saving of approximately 2000 bed-days per annum, releasing 5-6 acute beds per day.
肌钙蛋白I（TnI）检测对于胸痛患者的决策制定和管理至关重要。这些患者中TnI检测不到与30天内低死亡风险或心肌梗死风险相关，并且可能允许早期出院。
进行了一项审计，追踪出现胸痛并要求进行TnI血液检测的患者。对常规临床服务进行了为期三个月的审计。然后引入了“快速通道”肌钙蛋白服务和胸痛专科护士，以协助患者管理。持续三个月以评估对住院时间的影响。
在引入新措施的第一个三个月期间有446名患者入院，在第二个监测期有511名患者入院。从胸痛发作到进行TnI血液检测的时间从23.0小时缩短至20.3小时。从急性医疗接收单元（AMRU）入院到医院病房的患者百分比从62%降至53%（p<0.001）。新措施使入院时间从73.1小时减少至51.0小时。
快速通道肌钙蛋白检测和专科护士使胸痛患者的住院时间缩短了近24小时。这将每年节省约2000个床位日，每天腾出5至6张急性病床。
