title: Out-of-hours exercise treadmill testing reduces length of hospital stay for chest pain admissions.
abstract: OBJECTIVE
  The objective was to examine the impact of out-of-hours exercise treadmill tests (ETTs) on length of hospital stay (LOS) for patients admitted to a chest pain assessment unit with symptoms suggestive of acute coronary syndrome.
  
  
  METHODS
  Prospective observational study with 30-day follow-up of low-to-intermediate-risk chest pain patients undergoing out-of-hours ETT. Eligible patients had a nonischemic ECG, normal 6-12-h ST-segment monitoring, a negative 12-h troponin T assay, and no contraindications to exercise. Observed LOS was compared to expected LOS in the absence of out-of-hours ETT, using Wilcoxon rank-sum test. Estimated bed day savings and major adverse events at 30 days after discharge were examined.
  
  
  RESULTS
  Four hundred and twenty-two patients with a mean age of 52 years (SD 13 years, 25-83 years) were evaluated. Fifty-two per cent (n = 221) were men; 66% (n = 279) had one or less cardiovascular risk factors; and 79% (n = 334) of the patients presented on a Friday or Saturday. ETT was performed on a weekend day in 86% (n = 363) of the patients, facilitating same-day discharges in 71% (n =  300). The median LOS (interquartile range) was 1 day (1, 2 days) for patients assessed with out-of-hours ETT. The expected median LOS (IQR) was 3 days (2, 4 days) (P < 0.05) in the absence of out-of-hours ETT. Each out-of-hours ETT was estimated to save a mean (SD, range) of 1.6 (0.6, 1-4) bed days. Thirty-day mortality and readmission rates were 0 and 0.2% (1 of 422), respectively.
  
  
  CONCLUSIONS
  The availability of out-of-hours ETT facilitates safe early discharge and reduced LOS for low-to-moderate-risk patients admitted with symptoms of acute coronary syndrome.
authors: aDepartment of Cardiology bDepartment of Statistics cDepartment of Emergency Medicine, St James's Hospital, Dublin, Ireland.
authors: John D
authors: JD
authors: Groarke
authors: Peter
authors: P
authors: Crean
authors: Niamh
authors: N
authors: Adams
authors: Terence
authors: T
authors: Farrell
authors: Kathleen
authors: K
authors: Bennett
authors: C Geraldine
authors: CG
authors: McMahon
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000328:Adult; D039602:After-Hours Care / Q000379:methods*; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000209:etiology*; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods