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VIRTUAL CARDIAC DECISION UNIT ALGORITHM IMPROVES PATIENT OUTCOMES AND REDUCES COST
A128 JACC March 17, 2015 Volume 65, Issue 10S
Acute Coronary Syndromes Virtual Cardiac Decision Unit Algorithm Improves Patient Outcomes and Reduces Cost Poster Contributions Poster Hall B1 Sunday, March 15, 2015, 9:45 a.m.-10:30 a.m. Session Title: ECG, Cardiac Markers and Triage, Oh My! Abstract Category: 2. Acute Coronary Syndromes: Clinical Presentation Number: 1175-059 Authors: Bernardo Lombo, Osama Hallak, Harrington Dianna, Durham Rebecca, Bahadory Nader, Faisal Hasan, Erica Spatz, Michael Fucci, Yale University, New Haven, CT, USA
Background: Chest pain is the second most common reason for emergency department visits in United States. Hospitals across the country have opened observation units, but this strategy has not reduce the costs and unnecessary hospital bed occupation. The cardiac decision unit is a virtual unit setup in the Emergency Department for diagnosis and treatment of patients who have potential cardiac conditions that do not require hospital admission Methods: 5670 patients that presented with chest pain to a community hospital between August 2012 and May 2014 were admitted to the observation unit or treated according to a virtual cardiac diagnostic unit algorithm (CDUA). We compared the costs, length of stay, readmission rate, and mortality
Results: 565 patients were treated with the cardiac decision algorithm, Mean age 50.9 SD+/-10, female(54%), hypertension(12%),diabetes (3%),smoker (14%),dyslipidemia(8%),1233 patients were admitted to an observation unit. Mean age 59,7SD +/-14, female(55%), hypertens ion(10%),diabetes(4%),smoker (7%), dyslipidemia(8%). The average time spent in the Emergency Department for patients treated through the CDUA versus patients in the observation unit was 2.75 hours and 4.61 hours respectively,the average time spent in the facility were 12.24 hours and 28.65 hours respectively. Comparing 3 day readmits, the CDUA group had 2(0.3%)the observation group had 50(4%). The average cost per patient treated through the CDUA was $6197 and for the observation group $11561. 388(68%) CDUA patients underwent exercise stress testing compared to 134(10%) observation patients, 144(25,4%) CDUA patients had a myocardial perfusion stress test with MIBI, versus 862(70%) observation patients,64(11.3%) CDUA patients had a CT/ANGIO whereas 182 (14,7%) in the observation group had a CT/ANGIO, 33(5,8%)patients in the CDUA underwent no testing compared to 237(18,8%) patients from the observation unit. Both groups had 0% mortality at 3 days and 30 days
Conclusion: In this study we were able to show that patients treated using a Virtual Cardiac Diagnostic Unit algorithm in a community hospital setting was safe and with significantly lower costs and less time spent in the hospital
Acute Coronary Syndromes Virtual Cardiac Decision Unit Algorithm Improves Patient Outcomes and Reduces Cost Poster Contributions Poster Hall B1 Sunday, March 15, 2015, 9:45 a.m.-10:30 a.m. Session Title: ECG, Cardiac Markers and Triage, Oh My! Abstract Category: 2. Acute Coronary Syndromes: Clinical Presentation Number: 1175-059 Authors: Bernardo Lombo, Osama Hallak, Harrington Dianna, Durham Rebecca, Bahadory Nader, Faisal Hasan, Erica Spatz, Michael Fucci, Yale University, New Haven, CT, USA
Background: Chest pain is the second most common reason for emergency department visits in United States. Hospitals across the country have opened observation units, but this strategy has not reduce the costs and unnecessary hospital bed occupation. The cardiac decision unit is a virtual unit setup in the Emergency Department for diagnosis and treatment of patients who have potential cardiac conditions that do not require hospital admission Methods: 5670 patients that presented with chest pain to a community hospital between August 2012 and May 2014 were admitted to the observation unit or treated according to a virtual cardiac diagnostic unit algorithm (CDUA). We compared the costs, length of stay, readmission rate, and mortality
Results: 565 patients were treated with the cardiac decision algorithm, Mean age 50.9 SD+/-10, female(54%), hypertension(12%),diabetes (3%),smoker (14%),dyslipidemia(8%),1233 patients were admitted to an observation unit. Mean age 59,7SD +/-14, female(55%), hypertens ion(10%),diabetes(4%),smoker (7%), dyslipidemia(8%). The average time spent in the Emergency Department for patients treated through the CDUA versus patients in the observation unit was 2.75 hours and 4.61 hours respectively,the average time spent in the facility were 12.24 hours and 28.65 hours respectively. Comparing 3 day readmits, the CDUA group had 2(0.3%)the observation group had 50(4%). The average cost per patient treated through the CDUA was $6197 and for the observation group $11561. 388(68%) CDUA patients underwent exercise stress testing compared to 134(10%) observation patients, 144(25,4%) CDUA patients had a myocardial perfusion stress test with MIBI, versus 862(70%) observation patients,64(11.3%) CDUA patients had a CT/ANGIO whereas 182 (14,7%) in the observation group had a CT/ANGIO, 33(5,8%)patients in the CDUA underwent no testing compared to 237(18,8%) patients from the observation unit. Both groups had 0% mortality at 3 days and 30 days
Conclusion: In this study we were able to show that patients treated using a Virtual Cardiac Diagnostic Unit algorithm in a community hospital setting was safe and with significantly lower costs and less time spent in the hospital