Birkhahn Robert H, Wen Wendy, Datillo Paris A, Briggs William M, Parekh Amisha, Arkun Alp, Byrd Bethany, Gaeta Theodore J
Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
J Emerg Med. 2012 Aug;43(2):356-65. doi: 10.1016/j.jemermed.2011.06.046. Epub 2011 Oct 19.
The current paradigm for the evaluation of patients with suspected acute coronary syndromes (ACS) in the emergency department (ED) is focused on the identification of patients with active underlying coronary disease. The majority of patients evaluated in the ED setting do not have active underlying cardiac disease.
To measure the effect of bedside point-of-care (POC) cardiac biomarker testing on telemetry unit admissions from the ED. Furthermore, to evaluate the effect telemetry admissions have on ED length of stay (LOS) and overall hospital LOS.
Primary data were collected over two 6-month periods in an urban teaching hospital ED. This was an observational cohort study conducted pre- and post-availability of a POC testing platform for cardiac biomarkers. Major measures included number of overall telemetry admissions, ED LOS, hospital LOS, and disposition. Patients were followed at 30 days for significant cardiac events, repeat ED visit or admission, and death.
In the post-implementation period there was a 30% (95% confidence interval [CI] 36-44%) reduction in admissions to telemetry with a 33% (95% CI 26-39%) reduction in ED LOS and a 20% (95% CI 7-34%) reduction in hospital LOS. There was a 62% reduction in overall mortality between the pre-implementation period and the post-implementation period (p=0.001).
The focused use of a rapid cardiac disposition protocol can dramatically impact resource utilization, expedite patient flow, and improve short-term outcomes for patients with suspected ACS.
急诊科（ED）对疑似急性冠脉综合征（ACS）患者进行评估的当前模式主要集中于识别患有潜在活动性冠心病的患者。在急诊科接受评估的大多数患者并无潜在活动性心脏疾病。
评估床边即时检验（POC）心脏生物标志物检测对急诊科转入遥测监护病房住院的影响。此外，评估遥测监护病房住院对急诊科住院时长（LOS）及总体住院LOS的影响。
在一家城市教学医院急诊科的两个6个月期间收集原始数据。这是一项在POC心脏生物标志物检测平台可用之前及之后开展的观察性队列研究。主要指标包括遥测监护病房总体住院人数、急诊科LOS、住院LOS及出院情况。对患者进行30天随访，观察严重心脏事件、再次急诊就诊或住院及死亡情况。
在实施后阶段，转入遥测监护病房的住院人数减少了30%（95%置信区间[CI] 36 - 44%），急诊科LOS减少了33%（95% CI 26 - 39%），住院LOS减少了20%（95% CI 7 - 34%）。实施前阶段与实施后阶段相比，总体死亡率降低了62%（p = 0.001）。
集中使用快速心脏处置方案可显著影响资源利用、加快患者流程并改善疑似ACS患者的短期结局。
