301 The Financial Benefits of Implementing Cardiac Point of Care Testing of Emergency Department Chest Pain Patients

Abstract

Study Objectives: Glendale Memorial Hospital implemented point of care testing for cardiac biomarkers in their emergency department (ED) in May of 2010 using a rapid disposition protocol. The goal of the hospital was 2fold: 1) to reduce the turnaround time for these markers which would improve workflow for chest pain patients and decrease patient disposition times; and 2) to reduce unnecessary inpatient admissions by admitting more of these patients to an existing ED Chest Pain Unit (EDCPU). The hypothesis was that more appropriate disposition of patients should lead to reduced costs and increased reimbursements. Methods: The implementation included the use of multiple cardiac biomarkers (TnI, CK-MB, myoglobin, and BNP; Alere™ Triage® CardioProfilER) which were evaluated in a rapid (2 hour) serial draw protocol. The analyses performed were comparisons of laboratory versus point of care test turnaround time during the post-implementation period, comparisons of pre-implementation versus post-implementation patient disposition, and the financial impact of the differences in patient disposition. The statistical analysis used was Student's t-test for equality of means for paired data (Excel® 2007) for all of the analyses except turnaround time which used the Mann-Whitney test for equality of means with unequal variance (MedCalc®). The EDCPU began operation in September of 2009 and the POC implementation process was completed in May of 2010. Allowing at least 2 months as a “start-up” period for these 2 events resulted in a pre-implementation period from November 2009 through April 2010 and a post-implementation period of November 2010 through April 2011 (six months in each period). Results: The turnaround time for biomarker results was significantly less for the point of care tests than for those coming from the central laboratory (p<0.0001). For 1736 test results at the point of care the mean time from order to result was about 42 minutes and the median was 37 minutes. 14.2% of the results took longer than an hour. In contrast, for 2208 tests performed in the central laboratory the mean time from order to result was 94 minutes with a median time of 85 minutes. 77.5% of the results took longer than an hour. There were also significant differences in chest pain patient disposition in the pre- versus post-implementation time frames. Whereas there was no significant difference in disposition to telemetry beds, there were highly significant differences in >24 h admissions (26.7 per month versus 14.5 per month; p<0.003) and EDCPU admissions (19.5 per month versus 33.3 per month; p<0.0004) in the pre- versus post-implementation periods. This translated into an approximate $4500 increase in margin per month (p<0.04) which was about $54,000 in increased revenue per year. Conclusion: Institution of a rapid disposition protocol for chest pain patients increased the use of the EDCPU at Glendale Memorial Hospital which resulted in a net financial gain for the hospital.