title: Change to costs and lengths of stay in the emergency department and the Brisbane protocol: an observational study.
abstract: OBJECTIVE
  To compare health service cost and length of stay between a traditional and an accelerated diagnostic approach to assess acute coronary syndromes (ACS) among patients who presented to the emergency department (ED) of a large tertiary hospital in Australia.
  
  
  METHODS
  This historically controlled study analysed data collected from two independent patient cohorts presenting to the ED with potential ACS. The first cohort of 938 patients was recruited in 2008-2010, and these patients were assessed using the traditional diagnostic approach detailed in the national guideline. The second cohort of 921 patients was recruited in 2011-2013 and was assessed with the accelerated diagnostic approach named the Brisbane protocol. The Brisbane protocol applied early serial troponin testing for patients at 0 and 2 h after presentation to ED, in comparison with 0 and 6 h testing in traditional assessment process. The Brisbane protocol also defined a low-risk group of patients in whom no objective testing was performed. A decision tree model was used to compare the expected cost and length of stay in hospital between two approaches. Probabilistic sensitivity analysis was used to account for model uncertainty.
  
  
  RESULTS
  Compared with the traditional diagnostic approach, the Brisbane protocol was associated with reduced expected cost of $1229 (95% CI -$1266 to $5122) and reduced expected length of stay of 26 h (95% CI -14 to 136 h). The Brisbane protocol allowed physicians to discharge a higher proportion of low-risk and intermediate-risk patients from ED within 4 h (72% vs 51%). Results from sensitivity analysis suggested the Brisbane protocol had a high chance of being cost-saving and time-saving.
  
  
  CONCLUSIONS
  This study provides some evidence of cost savings from a decision to adopt the Brisbane protocol. Benefits would arise for the hospital and for patients and their families.
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Qinglu
authors.initials: Q
authors.lastname: Cheng
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Jaimi H
authors.initials: JH
authors.lastname: Greenslade
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: William A
authors.initials: WA
authors.lastname: Parsonage
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Adrian G
authors.initials: AG
authors.lastname: Barnett
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Katharina
authors.initials: K
authors.lastname: Merollini
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Graves
authors.affiliation: Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D001315:Australia; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000209:etiology; D002985:Clinical Protocols; D017046:Cost Savings; D003663:Decision Trees; D004636:Emergency Service, Hospital / Q000191:economics* / Q000458:organization & administration*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D062606:Tertiary Care Centers / Q000191:economics / Q000458:organization & administration; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D014336:Troponin
keywords: acute coronary syndrome; chest pain; emergency department