DENVER – Adopting troponin I point-of-care testing in the emergency department for patients presenting with chest pain significantly cuts door-to-troponin-result times and shortens ED length-of-stay, according to Dr. George Hertner of Memorial Hospital, Colorado Springs, Colo.
Traditionally, troponin testing entails sending a blood sample to a hospital’s central lab. That’s a rate-limiting step that slows patient flow through the ED, he said at the annual meeting of the American College of Emergency Physicians.
Dr. Hertner presented a retrospective before-and-after study involving 5,251 consecutive patients who presented with chest pain to the Memorial Hospital ED and for whom a cardiac troponin test was ordered. A total of 344 patients were from the pre–point-of-care-test era; their samples were sent to the hospital’s central lab for triple-marker testing of cardiac troponin, creatine kinase MB and myoglobin. A CBC, comprehensive metabolic panel, and basic metabolic panel tests were also routinely performed. The subsequent 4,907 patients underwent troponin I point-of-care testing in the ED. During both testing periods, the ED averaged 48-50 visits per day by patients with chest pain.
The mean door-to-troponin-result time dropped by 51% after the introduction of point-of-care testing, from 105 minutes to 51 minutes. The average ED length of stay for chest pain patients decreased from 290 minutes when troponin testing was done in the central lab to 255 minutes with point-of-care testing. And with the hospital’s central lab freed from having to perform troponin assays, the lab’s turnaround time for CBCs and comprehensive metabolic panels dropped by 25 minutes, from an average of 50 minutes in the pre–point-of-care-test era to 25 minutes.
Surveys of ED physicians, nurses, and technicians found a high degree of satisfaction with bedside point-of-care troponin testing using the i-STAT system marketed by Abbott Point of Care. They stated that the test improved staff productivity, patient flow, and quality of care.
In an ACEP conference wrap-up session highlighting the top research presented at the annual meeting, panelist Dr. Judd E. Hollander singled out Dr. Hertner’s study for special attention. He said that while the reported 35-minute reduction in ED length of stay for chest pain patients after introduction of troponin I point-of-care testing is meaningful, what really caught his eye was the 25-minute decrease in turnaround time for other tests that was accomplished by taking troponin measurement away from the hospital’s central lab.
"That’s got the potential to be a really big savings. We have point-of-care troponin testing in our ED, too, but I never really thought about what it does for the turnaround time for other tests. To me, this is a big, clinically relevant finding that to the best of my knowledge no one has ever looked at before with point-of-care biomarker testing," said Dr. Hollander, professor of emergency medicine at the University of Pennsylvania, Philadelphia.
This study was funded by Abbott. Dr. Hertner is on the speakers bureau for the company.