A middle-age man is at home one night and suddenly experiences chest pains, upper body pain, and shortness of breath. The symptoms point to one conclusion heart attack. Hopefully, an ambulance arrives and the man is taken in immediately to the emergency department (ED) of the nearest hospital, where he would be rushed into the care of attending ED physicians. Sounds somewhat cut and dry, doesn't it?
But what if that same man had somewhat more ambiguous symptoms? What if he walked in under his own power to the ED and complained that he had some discomfort in the chest area or shortness of breath and wasn't sure what to do about it? Questions would be asked, tests ordered, and results analyzed. Then the waiting game begins for both doctor and patient.
A recent statistical analysis from the Centers for Disease Control conclude that the average time that hospital emergency room patients wait to see a doctor has grown from about 38 minutes to almost an hour over the past decade. Overall, about 119 million visits were made to U.S. emergency rooms in 2006, up from 90 million in 1996 - a 32% increase. Meanwhile, the number of hospital emergency departments dropped to fewer than 4,600, from nearly 4,900, according to American Hospital Association statistics.
This problem of increased ED length of stay is the focus of a recent study published in the Annals of Emergency Medicine. The study, "A Multicenter Randomized Controlled Trial Comparing Central Laboratory and Point-of-Care Cardiac Marker Testing Strategies," focuses on point-of-care (POC) testing as a way to reduce time to cardiac marker results in patients evaluated with acute coronary syndromes.
A lead author of the study, Richard Ryan, MD, of University of Cincinnati School of Medicine told Medical Device Daily that: "The majority of patients come in with vague chest pains; they're not having a heart attack nor need an EKG, so you need to order tests. That's where this POC device saves an incredible amount of time compared to the central labs. [The majority of time] is lost waiting for test results. With the POC test, it is done at the patient's side and the result is handed directly to the doctor."
This POC test he refers to is the i-STAT, made by Abbott Laboratories (Abbott Park, Illinois). The i-STAT resembles a television remote control in shape and size and features single-use disposable cartridges that can be used throughout the hospital to perform a menu of critical care tests, including cardiac markers, blood gases, chemistries and electrolytes, lactate, coagulation and hematology. The i-STAT menu includes prognostic, diagnostic, and treatment indicators related to disease state management and clinical practice guidelines. Using just two or three drops of blood, the system can provide time-sensitive test results in minutes.
This device can allow for more patient satisfaction, and a more efficient use of ED physician's time. Ryan gives an example: "If I can get a low-risk chest pain patient that I know I have to get cardiac enzymes on, instead of waiting 2-3 hours to get the results from the lab, I can now get them in 15 minutes, then order another one, etc. Then I can send those patients home. That's a huge benefit. If you can get 2-3 patients out quicker that way, it saves about an hour's time. That also allows us to see more patients that day."
The study was conducted at multiple hospital sites, and the overall conclusions were mixed. At some sites the POC testing decreased time to admission, and at others, produced longer stays. But the general feeling with the authors is optimistic and more data gathering is needed. "There are many ways the research will move forward. One way is to capitalize on getting the cardiac marker test results back faster with looking at how to speed up other information the doctors need to make decisions, and how to change the flow of information to make it simpler," Christopher Lindsell, PhD, another author of the study told MDD.
The i-STAT complements the clinical lab's efforts by providing lab-quality results for the most critically needed tests while improving efficiency throughout the continuum of care. Abbott says that the i-STAT analyzer is currently in use in one out of every three U.S. hospitals (a total of 1,800) and over 500 emergency departments.