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Chest Pain Unit Using Thrombolysis in Myocardial Infarction Score Risk Stratification: An Impact on the Length of Stay and Cost Savings.
MedLine Citation:
PMID:  23149363     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Despite the fact that studies have demonstrated cost-effectiveness of chest pain observation units (CPOUs) in emergency departments, they have not been widely implemented. Thrombolysis in Myocardial Infarction (TIMI) score is an easy and reliable tool, but none of the prior studies have used it for risk stratification in CPOUs. We propose to study the impact of CPOU using TIMI risk stratification model on the length of stay (LOS) and cost savings. METHODS:: We studied 777 patients with chest pain admitted to our hospital from July 2010 to June 2011. The patients with a TIMI score of 0 to 2 were observed for 12 hours, those with a score of 3 to 4 were observed for 20 hours, and the ones with a score >4 were deemed appropriate for admission. We calculated the cost differences between the actual admissions and the CPOU. RESULTS:: A total of 39.1% of patients had a TIMI score of 0, 31.1% had a TIMI score of 1, 18.1% had a TIMI score of 2, 9.2% and 2.5% had TIMI scores of 3 and 4, respectively. The expected LOS based on this model was 418.5 days versus the actual LOS of 1324 days. The cost of CPOU was estimated to be $1,979,977. However, the actual cost was $3,216,809. Hence, the annual cost savings were estimated to be $1,236,832. CONCLUSION:: CPOU using TIMI score is an easy and reliable risk stratification tool for patients with chest pain in the emergency department and can significantly reduce the LOS, hence saving millions of dollars in this economic crisis.
Priyank P Shah; Nishant Gupta; Anurag Sharma; Rishi K Bhargava; Sharad Bajaj; Vipin Mittal; Cynthia Johnson; Fayez Shamoon; Mahesh Bikkina
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Publication Detail:
Journal Detail:
Title:  Critical pathways in cardiology     Volume:  11     ISSN:  1535-2811     ISO Abbreviation:  Crit Pathw Cardiol     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101165286     Medline TA:  Crit Pathw Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  206-210     Citation Subset:  -    
From the Departments of *Internal Medicine and †Cardiology, St. Joseph's Regional Medical Center, Paterson, NJ; and the Departments of ‡Business Administration and §Cardiology, St. Michael's Medical Center, Newark, NJ.
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