Department of Emergency Services, Sunnybrook Health Sciences Centre, Sunnybrook Health Sciences Center, Toronto, ON, Canada.
Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
CJEM. 2023 Nov;25(11):909-919. doi: 10.1007/s43678-023-00595-y. Epub 2023 Sep 27.
High-sensitivity troponin (hsTn) accelerated diagnostic protocols are highly recommended for evaluating acute coronary syndromes. Our goal was to improve care for chest pain patients through the safe adoption of an accelerated diagnostic protocol in our academic Emergency Department (ED) with an aim to reduce mean ED length of stay for chest pain patients by 1 h over 1.5 years. Pre-accelerated diagnostic protocol, our mean ED length of stay for chest pain patients was 9.0 h.
Using the Model for Improvement, we implemented a two-hour accelerated diagnostic protocol and conducted two Plan-Do-Study-Act cycles and education efforts to improve accelerated diagnostic protocol compliance and decrease ED length of stay. Using control charts, we measured the mean monthly ED length of stay for chest pain patients to look for special cause evidence of improvement. Process measures measured compliance with the accelerated diagnostic protocol. Balancing measures included the ED length of stay for abdominal pain patients and the number of admissions and deaths at 7 days for chest pain patients.
Mean ED length of stay for chest pain patients decreased from 9.0 to 8.2 h post-accelerated diagnostic protocol. The mean time between troponins decreased from 3.9 to 3.0 h, and the percentage of second troponins repeated at < 2.75 h increased from 22.3% to 58.6%. For abdominal pain patients, ED length of stay decreased from 10.8 to 10.5 h. No chest pain patients died within 7 days pre- or post-accelerated diagnostic protocol. Pre-accelerated diagnostic protocol, 0.84% (41/4,905) were admitted within 7 days. Post-accelerated diagnostic protocol and accelerated diagnostic protocol compliant, 0.70% (13/1,844) were admitted. Post-accelerated diagnostic protocol and accelerated diagnostic protocol non-compliant, 1.1% (13/1,183) were admitted.
We safely introduced a hsTn accelerated diagnostic protocol in an academic ED. ED length of stay decreased for chest pain patients but did not meet our 1-h goal.
高敏肌钙蛋白（hsTn）加速诊断方案强烈推荐用于评估急性冠状动脉综合征。我们的目标是通过在我院急诊部安全采用加速诊断方案，改善胸痛患者的治疗，旨在 1.5 年内将胸痛患者的平均急诊停留时间缩短 1 小时。在引入加速诊断方案之前，我们的胸痛患者平均急诊停留时间为 9.0 小时。
我们使用改进模型，实施了两小时加速诊断方案，并进行了两轮计划-执行-研究-行动循环和教育工作，以提高加速诊断方案的依从性并减少急诊停留时间。我们使用控制图衡量胸痛患者每月的平均急诊停留时间，以寻找改进的特殊原因证据。过程测量指标衡量加速诊断方案的依从性。平衡测量指标包括腹痛患者的急诊停留时间和胸痛患者 7 天内的入院人数和死亡人数。
胸痛患者的平均急诊停留时间从加速诊断方案实施后的 9.0 小时降至 8.2 小时。肌钙蛋白之间的平均时间从 3.9 小时缩短至 3.0 小时，2.75 小时内重复第二份肌钙蛋白的比例从 22.3%提高至 58.6%。对于腹痛患者，急诊停留时间从 10.8 小时降至 10.5 小时。在加速诊断方案实施前后，均无胸痛患者在 7 天内死亡。在加速诊断方案实施之前，0.84%（41/4905）的患者在 7 天内入院。在加速诊断方案实施之后且符合加速诊断方案的情况下，0.70%（13/1844）的患者入院。在加速诊断方案实施之后且不符合加速诊断方案的情况下，1.1%（13/1183）的患者入院。
我们在一所学术急诊部安全引入了 hsTn 加速诊断方案。胸痛患者的急诊停留时间缩短，但未达到我们的 1 小时目标。
