503 Implementation of a High Sensitivity Troponin Assay and Overnight Rapid Emergency Department (ED) Discharge of Intermediate Risk Patients: Impact on the ED Length of Stay

Abstract

Rapid evaluation and discharge of patients presenting with chest pain is a key goal of emergency care. We evaluated the length of stay before and after the implementation of a high-sensitivity troponin assay and a new protocol for overnight rapid ED discharge of intermediate risk patients at The Prince Charles Hospital. Patients aged >18years referred with low and intermediate-risk chest pain between 2018 and 2019 presenting to the Chest Pain Assessment Unit were examined using a before and after study design. Pre-intervention group were assessed using the Beckman-Coulter second generation AccuTnI assay (June-October 2018). Post-intervention (September-November 2019), patients were assessed using the High-Sensitive STAT Troponin-I assay (Abbott Laboratories). Post-intervention, intermediate risk patients presenting to ED overnight were also discharged from ED with outpatient functional testing if they had 2 negative serial troponins (3hours apart) and normal serial ECGs, routine blood tests and a chest x-ray. The primary outcome was the ED length of stay. The study consisted of 634 patients (mean age 59.7y±5.1y, 51% females, 35% low-risk and 65% intermediate-risk chest pain). The pre-intervention group (n=308 patients, mean age 61.3y±13.6, 48% female, 33% low and 67% intermediate risk) were comparable with the post-intervention group (n=326 patients, mean age 58.7y±12, 53% female, 36% low and 64% intermediate risk). The ED length of stay was significantly shorter post-intervention (mean LOS 8.6 v 5.2 hrs, p<0.001). Implementing a high-sensitivity troponin assay and protocol driven discharge of chest pain patients overnight is associated with a significantly lower ED length of stay.