title: Implementation of a rapid whole blood D-dimer test in the emergency department of an urban academic medical center: impact on ED length of stay and ancillary test utilization.
abstract: Overcrowding and prolonged patient length-of-stay (LOS) in emergency departments (EDs) are growing problems. We evaluated the impact of implementing a rapid whole blood quantitative D-dimer test (Biosite Triage, Biosite Diagnostics, San Diego, CA) in our ED satellite laboratory on 252 patients before vs 211 patients after implementation. All patients also underwent testing with the existing central laboratory method (VIDAS D-dimer, bioMérieux, Durham, NC). D-dimer turnaround time (from blood draw to result) decreased approximately 79% (approximately 2 hours vs 25 minutes). The mean ED LOS declined from 8.46 to 7.14 hours (P = .016). Hospital admissions decreased 13.8%, ED discharges increased 7.3%, and the number of patients admitted for observation increased 6.4% (P = .005). No difference in the utilization of radiologic studies was observed (P = .86). At 3 months' follow-up, none of the after-implementation patients with negative D-dimer results were admitted for subsequent venous thromboembolic disease. The rapid D-dimer test was associated with a shorter ED LOS and fewer hospital admissions.
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lee-Lewandrowski
authors.forename: John
authors.initials: J
authors.lastname: Nichols
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Van Cott
authors.forename: Ricky
authors.initials: R
authors.lastname: Grisson
authors.forename: Abner
authors.initials: A
authors.lastname: Louissaint
authors.forename: Theodore
authors.initials: T
authors.lastname: Benzer
authors.forename: Kent
authors.initials: K
authors.lastname: Lewandrowski
mesh_terms: D000046:Academic Medical Centers; D001774:Blood Chemical Analysis / Q000379:methods; D004636:Emergency Service, Hospital; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006786:Hospitals, Urban; D006801:Humans; D007902:Length of Stay; D010343:Patient Admission; D019095:Point-of-Care Systems; D012680:Sensitivity and Specificity; D013997:Time Factors; D019037:Urban Health Services; D014505:Urban Population; D054556:Venous Thromboembolism / Q000097:blood*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D