Estimating the clinical impact of bringing a multimarker cardiac panel to the bedside in the ED.
OBJECTIVE
We examined the use of point-of-care (POC) testing of cardiac biomarkers against standard core laboratory testing to determine the time-savings and estimate a cost-benefit ratio at our institution.


METHODS
We prospectively enrolled 151 patients presenting to the emergency department undergoing evaluation for acute coronary syndrome and conducted both central laboratory troponin T (TnT) testing at baseline and 6 hours as well as POC assays of creatine kinase MB, troponin I (TnI), and myoglobin at baseline and 2 hours. Sensitivity/specificity was calculated to measure the ability of the POC-accelerated pathway to identify enzyme elevations at rates parallel to our core laboratory. The time-savings were calculated as the difference between the median of the current protocol and the accelerated POC pathway.


RESULTS
Troponin T tests were elevated in 12 patients, which were all detected by the accelerated pathway yielding a relative sensitivity of 100%. Time-saving between the accelerated pathway and core laboratory showed a saving of 390 minutes (6.5 hours). The accelerated POC pathway would have benefited 60% (95% confidence interval [CI], 52%-68%) of our patients with an estimated cost of $7.40 (95% CI, $6.40-$8.70) per direct patient care hour saved.


CONCLUSIONS
Our data suggest that the use of an accelerated cardiac POC pathway could have dramatically impacted the care provided to a large percentage of our patients at a minimal cost per direct patient care hour saved.
Birkhahn
Robert H
RH
Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY 11215, USA. rhbirkhahn@pol.net
Haines
Elizabeth
E
Wen
Wendy
W
Reddy
Lakshmi
L
Briggs
William M
WM
Datillo
Paris A
PA
D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D017046:Cost Savings; D052279:Creatine Kinase, MB Form / Q000097:blood; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009211:Myoglobin / Q000097:blood; D019095:Point-of-Care Systems / Q000191:economics / Q000706:statistics & numerical data; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; D009211:Myoglobin; D019210:Troponin I; D020107:Troponin T; D052279:Creatine Kinase, MB Form