P5519Effects of crowding in the emergency department on time dependent processes and outcomes using fast diagnostic protocols in patients with suspected acute coronary syndrome

Abstract

Abstract Background Accelerated diagnostic algorithms using high-sensitivity troponin (hsTn) assays in suspected acute coronary syndrome (ACS) are regarded as particularly beneficial to expedite diagnosis and safe discharge of low risk patients in crowded emergency departments (ED). However, little is known about potential negative effects of crowding on implementation and efficacy of fast diagnostic protocols. We studied the effects of crowding on outcomes and process times in patients admitted with suspected ACS using fast diagnostic protocols. Methods A total of 2,525 consecutive patients were evaluated during 12 months using 2015 ESC guideline recommended fast protocols. Crowding was defined as mismatch between patient visits and monitoring capacities as well as effective physician time per case. Electronic time-stamps were available for length of ED stay, timing of hsTnT measurements, time intervals between measurements, and laboratory turn-around-times (TAT). Patients were followed up for all-cause mortality at 30 days and 1 year. Results Crowding was associated with increasing intervals between blood samples from 98 to 107 minutes (p=0.008), increasing median TAT from 53 to 57 minutes (p<0.001), significantly higher numbers of additional hsTnT measurements after diagnosis (p<0.001 for trend), and a trend for more frequent hospital discharge (58.9 vs. 62.8%, p=0.08) across crowding levels. There were indirect findings for additional negative effects on time dependent care processes. However, there was no significant effect of crowding on 30-day (1.8 vs. 1.9%) or 1-year all-cause mortality (5.4 vs. 5.9%). Conclusion Time-dependent processes are prolonged in a crowded ED diminishing some positive effects of fast diagnostic protocols for evaluation of suspected ACS. Acknowledgement/Funding Roche Diagnostics International Ltd.