title: Chest pain unit using thrombolysis in myocardial infarction score risk stratification:  an impact on the length of stay and cost savings.
abstract: BACKGROUND
  Despite the fact that studies have demonstrated cost-effectiveness of chest pain observation units (CPOUs) in emergency departments, they have not been widely implemented. Thrombolysis in Myocardial Infarction (TIMI) score is an easy and reliable tool, but none of the prior studies have used it for risk stratification in CPOUs. We propose to study the impact of CPOU using TIMI risk stratification model on the length of stay (LOS) and cost savings.
  
  
  METHODS
  We studied 777 patients with chest pain admitted to our hospital from July 2010 to June 2011. The patients with a TIMI score of 0 to 2 were observed for 12 hours, those with a score of 3 to 4 were observed for 20 hours, and the ones with a score >4 were deemed appropriate for admission. We calculated the cost differences between the actual admissions and the CPOU.
  
  
  RESULTS
  A total of 39.1% of patients had a TIMI score of 0, 31.1% had a TIMI score of 1, 18.1% had a TIMI score of 2, 9.2% and 2.5% had TIMI scores of 3 and 4, respectively. The expected LOS based on this model was 418.5 days versus the actual LOS of 1324 days. The cost of CPOU was estimated to be $1,979,977. However, the actual cost was $3,216,809. Hence, the annual cost savings were estimated to be $1,236,832.
  
  
  CONCLUSIONS
  CPOU using TIMI score is an easy and reliable risk stratification tool for patients with chest pain in the emergency department and can significantly reduce the LOS, hence saving millions of dollars in this economic crisis.
authors.affiliation: Department of Internal Medicine, St. Joseph's Regional Medical Center, 703 Main St., Paterson, NJ 07503, USA. priyank_221084@yahoo.com.
authors.forename: Priyank P
authors.initials: PP
authors.lastname: Shah
authors.forename: Nishant
authors.initials: N
authors.lastname: Gupta
authors.forename: Anurag
authors.initials: A
authors.lastname: Sharma
authors.forename: Rishi K
authors.initials: RK
authors.lastname: Bhargava
authors.forename: Sharad
authors.initials: S
authors.lastname: Bajaj
authors.forename: Vipin
authors.initials: V
authors.lastname: Mittal
authors.forename: Cynthia
authors.initials: C
authors.lastname: Johnson
authors.forename: Fayez
authors.initials: F
authors.lastname: Shamoon
authors.forename: Mahesh
authors.initials: M
authors.lastname: Bikkina
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000175:diagnosis* / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D017046:Cost Savings / Q000706:statistics & numerical data*; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005080:Exercise Test; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D009515:New Jersey; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy / Q000191:economics / Q000379:methods*
chemical_list: D015415:Biomarkers