Improving Management of Chest Pain with a High Sensitivity Troponin Based Prootocol
Chest pain is one of the most common presenting complaints to emergency departments in the United States. Management typically centers on ruling in or out myocardial infarction, or other forms of major adverse cardiac events which are overall rare diagnoses. The high sensitivity troponin assay can detect abnormal troponin elevations at 10-to-100-fold lower levels compared to traditional troponin assays, and thus can allow faster time to disposition and diagnosis. This has implications for improving length of stay in the emergency department, and earlier and more accurate identification of those presenting with myocardial infarction. The aim of this study was to evaluate the effect that a high sensitivity troponin assay combined with a chest pain clinical management protocol based on the HEART score would have on emergency department length of stay and disposition for patients presenting for evaluation of chest pain across Main Line Health acute care hospitals. This intervention was able to achieve a reduction in emergency department length of stay, increase the number of patients discharged home from the emergency department, and reduce the number of patients admitted to observation and inpatient status. A $1 million cost savings was noted after one year related to reduction in unnecessary observation admissions. The intervention was additionally associated with reduction in use of stress testing, echocardiograms and cardiology consultations for patients admitted to observation status.
Recommended CitationLohr, MD, Kristin, "Improving Management of Chest Pain with a High Sensitivity Troponin Based Prootocol" (2023). Master of Science in Healthcare Quality and Safety Capstone Presentations. Presentation 81.