PMID- 37759142
OWN - NLM
STAT- MEDLINE
DCOM- 20231116
LR  - 20231121
IS  - 1481-8043 (Electronic)
IS  - 1481-8035 (Linking)
VI  - 25
IP  - 11
DP  - 2023 Nov
TI  - Impact of a high sensitivity troponin accelerated diagnostic protocol on the 
      safety and emergency department length of stay of chest pain in an academic 
      tertiary hospital: a quality improvement study.
PG  - 909-919
LID - 10.1007/s43678-023-00595-y [doi]
AB  - PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
CI  - (c) 2023. The Author(s), under exclusive licence to Canadian Association of 
      Emergency Physicians (CAEP)/ Association Canadienne de Medecine d'Urgence (ACMU).
FAU - Phillips, Dana
AU  - Phillips D
AUID- ORCID: 0000-0003-0173-1852
AD  - Department of Emergency Services, Sunnybrook Health Sciences Centre, Sunnybrook 
      Health Sciences Center, Toronto, ON, Canada. Dana.kozubal@gmail.com.
AD  - Division of Emergency Medicine, Department of Medicine, University of Toronto, 
      Toronto, ON, Canada. Dana.kozubal@gmail.com.
FAU - Shelton, Dominick
AU  - Shelton D
AD  - Department of Emergency Services, Sunnybrook Health Sciences Centre, Sunnybrook 
      Health Sciences Center, Toronto, ON, Canada.
AD  - Department of Family and Community Medicine, University of Toronto, Toronto, ON, 
      Canada.
FAU - Verma, Aikta
AU  - Verma A
AD  - Department of Emergency Services, Sunnybrook Health Sciences Centre, Sunnybrook 
      Health Sciences Center, Toronto, ON, Canada.
AD  - Division of Emergency Medicine, Department of Medicine, University of Toronto, 
      Toronto, ON, Canada.
FAU - Liu, Samantha
AU  - Liu S
AD  - Department of Emergency Services, Sunnybrook Health Sciences Centre, Sunnybrook 
      Health Sciences Center, Toronto, ON, Canada.
FAU - Yeung, Vincent
AU  - Yeung V
AD  - Department of Emergency Services, Sunnybrook Health Sciences Centre, Sunnybrook 
      Health Sciences Center, Toronto, ON, Canada.
FAU - Cheng, Ivy
AU  - Cheng I
AUID- ORCID: 0000-0001-7740-9558
AD  - Department of Emergency Services, Sunnybrook Health Sciences Centre, Sunnybrook 
      Health Sciences Center, Toronto, ON, Canada.
AD  - Division of Emergency Medicine, Department of Medicine, University of Toronto, 
      Toronto, ON, Canada.
LA  - eng
PT  - Journal Article
DEP - 20230927
PL  - England
TA  - CJEM
JT  - CJEM
JID - 100893237
RN  - 0 (Troponin I)
SB  - IM
MH  - Humans
MH  - *Troponin I
MH  - Length of Stay
MH  - Tertiary Care Centers
MH  - Quality Improvement
MH  - Chest Pain/diagnosis/etiology
MH  - Emergency Service, Hospital
MH  - *Acute Coronary Syndrome/diagnosis
MH  - Abdominal Pain
OTO - NOTNLM
OT  - Accelerated diagnostic protocol
OT  - Chest pain
OT  - Emergency department
OT  - High sensitivity troponin
OT  - Length of stay
EDAT- 2023/09/28 00:42
MHDA- 2023/11/16 06:45
CRDT- 2023/09/27 23:40
PHST- 2022/11/17 00:00 [received]
PHST- 2023/09/04 00:00 [accepted]
PHST- 2023/11/16 06:45 [medline]
PHST- 2023/09/28 00:42 [pubmed]
PHST- 2023/09/27 23:40 [entrez]
AID - 10.1007/s43678-023-00595-y [pii]
AID - 10.1007/s43678-023-00595-y [doi]
PST - ppublish
SO  - CJEM. 2023 Nov;25(11):909-919. doi: 10.1007/s43678-023-00595-y. Epub 2023 Sep 27.