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首页> 外文期刊>Journal of Clinical Medicine Research >Impact of Chest Pain Protocol Targeting Intermediate Cardiac Risk Patients in an Observation Unit of an Academic Tertiary Care Center
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Impact of Chest Pain Protocol Targeting Intermediate Cardiac Risk Patients in an Observation Unit of an Academic Tertiary Care Center

机译：以三级心脏风险患者为目标的胸痛方案对学术三级护理中心观察室的影响

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Background: Chest pain (CP) is a frequent cause of emergency room visits in United States and adds a huge financial burden to our healthcare cost. With the addition of observation units, standard CP protocols have shown to decrease length of stay (LOS) and cost per discharge (CPD). We report our experience with the development and implementation of “CP protocol for intermediate cardiac risk patients” and its impact on healthcare resource utilization at our medical center.Methods and Results: We retrospectively analyzed 30 patients who presented to Advocate Christ Medical Center (ACMC) with CP and were considered to be at intermediate risk for acute coronary syndrome after obtaining IRB approval. Patients were treated with our standardized CP protocol and labeled as “protocol patients”. Our control group consisted of patients with similar demographics and diagnosis but not treated with our CP protocol admitted in the same time period and under our own faculty. This helped remove the bias of different treating attending. Our protocol algorithm consisted of medications, an electrocardiogram (EKG), cardiac troponin I level, and a stress test if indicated. Primary clinical endpoints for this study were LOS in hours and CPD for patients in our protocol group compared to control group. LOS in the protocol group was lower compared to the control but the difference was not statistically significant (P = 0.74). The average CPD in the control group (mean = $13,446) was almost $830 more than the protocol group (mean = $14,276, P = 0.827).Conclusion: Implementation of standardized protocols for patients with CP has proven to be a cost effective strategy at several institutions across the country. Our study showed a reduction in CPD although not statistically significant. LOS was also reduced but did not meet statistical significance mainly due to our small sample size. Previous studies had demonstrated much larger savings between a protocol-driven group and a non-protocol-driven group. On further analysis of our data, our protocol group contained five patients who underwent invasive diagnostic tests including computed tomography for pulmonary embolism scans which were not present in the control group. This accounted for the small reduction in costs for the protocol group.J Clin Med Res. 2016;8(2):111-115doi: http://dx.doi.org/10.14740/jocmr2441w
机译：背景：胸痛（CP）是美国急诊就诊的常见原因，并给我们的医疗保健费用增加了巨大的财务负担。通过增加观察单元，标准的CP协议已显示出可以减少住院时间（LOS）和每次放电成本（CPD）。我们报告了我们在开发和实施“中度心脏病患者的CP方案”方面的经验及其对我们医疗中心的医疗资源利用的影响。方法和结果：我们回顾性分析了30名患者，这些患者曾就诊于Advocate Christ Medical Center（ACMC） CP且获得IRB批准后被视为处于急性冠状动脉综合征的中等风险。使用我们标准化的CP方案治疗患者，并标记为“协议患者”。我们的对照组由人口统计学和诊断相近的患者组成，但未在同一时期由我们自己的教职人员接受CP方案治疗。这有助于消除不同治疗主治的偏见。我们的协议算法包括药物，心电图（EKG），心肌肌钙蛋白I水平和压力测试（如果有提示）。这项研究的主要临床终点是协议组患者与对照组相比的小时LOS和CPD。与对照组相比，方案组的LOS较低，但差异无统计学意义（P = 0.74）。对照组的平均CPD（平均值= $ 13,446）比方案组（平均值= $ 14,276，P = 0.827）高出近830美元。结论：对于CP患者实施标准化方案已被证明是一种经济有效的策略遍布全国的机构。我们的研究显示CPD降低，尽管无统计学意义。 LOS也有所减少，但由于我们的样本量较小，因此未达到统计学意义。先前的研究表明，协议驱动的小组和非协议驱动的小组之间可以节省更多的钱。在对我们的数据进行进一步分析时，我们的方案组包括五名患者，他们接受了侵入性诊断测试，包括计算机断层扫描以进行对照组的肺栓塞扫描。这使得方案组的成本有所降低。JClin Med Res。 2016; 8（2）：111-115doi：http://dx.doi.org/10.14740/jocmr2441w

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