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USING POINT-OF-CARE CARDIAC MARKERS IN LOW RISK CHEST PAIN IN THE EMERGENCY DEPARTMENT
  1. James Griffiths,
  2. Julian Humphrey,
  3. Sally-Anne Pearson,
  4. David Pallot
  1. Barnsley Hospital NHS Foundation Trust, Barnsley, UK

    Abstract

    Background Barnsley Emergency Department, which recruited patients into the RATPAC trial, initiated a POC pathway for low-risk chest pain patients from December 2011. A preceding audit estimated that 50% of chest pain patients may be suitable for discharge from the ED.

    Methods All patients who underwent POC testing for chest pain between December 2011 and July 2012 were identified from the Radiometer AQT™ database. Patient notes were then examined using Filestream™ data record system and time spent within the ED was assessed using Extramed™ patient tracking system.

    Results A total of 1039 patients underwent POC testing during the period. Of these, 9 sets of notes were missing, giving a sample of 1030 patients. The age range was 16–96 (mean age 53.7 years) and 553 (54%) patients were male.

    Admissions: 649 patients were discharged from the ED (63%). However, when high risk patients and those admitted for other reasons (different diagnosis or social reasons), this percentage rises to 83% (649 discharges from 784 appropriate POC patients).

    Re-attendances: There were a total of 137 re-attendances within one month (13% of all patients). When unrelated attendances are removed, the number of significant re-attendances was 43 (4% of patients).

    Breaches: There were a total of 120 patients (11.6%) who breached the 4-hour access standard. During the 8-month period, there were a total of 2147 breaches and the average 4-hour performance for the trust was 95.65%. For the same period in the previous year, there were 2779 breaches and the average 4-hour performance was 94.27%

    Conclusion Our pilot work would suggest that the use of POC cardiac markers in chest pain can facilitate discharge of low risk patients from the Emergency Department without a significant re-attendance rate or impacting on the 4-hour access standard.

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