The Evolution of a New Standard of Hospital Care: Paradigm Shift to the Emergency Department and the Role of Point-of-Care Testing

摘要

The objective of this project was to examine what impact point-of-care testing (POCT) had in the length of stay (LOS), emergency department (ED) patient disposition and placement, and outcomes of acute coronary syndrome (ACS) and acute myocardial infarction patients. Methods: Using a multidisciplinary team approach, POCT was initiated in the ED. Pre-POCT and post-POCT data for vein-to-brain time, ED volume, LOS, ACS volumes, patient satisfaction, and financial data were abstracted. Results: POCT resulted in a 70-minute or 450% change in vein-to-brain time. During the time from pre-POCT to post-POCT, the ED volume increased by almost 4000 patients. The LOS went from 2.35 to 2.16 days. The non-ST-elevation myocardial infarction volume increased significantly from 21 to 105, a 500% change. Conclusions: There are 5 conclusions from this project: (1) the foundation for successful outcomes begins with ACS disease process education from various multidisciplinary perspectives; (2) POCT and ACS process redesign are a journey that must include a multidisciplinary team to be successful; (3) providing accurate diagnostic results to clinicians earlier impacts both quality and cost; (4) a patient-centric improvement effort must be the shared vision of both internal and external resources (ie, vendor partnership and emergency medical services) to be successful. (5) This template may provide an avenue for future disease state management initiatives. West Houston Medical Center is located in Houston, Tex, and is a 220-bed facility. West Houston Medical Center is the first chest pain center accredited in Texas and the third in the nation.