High-sensitivity troponin protocol most successful at freestanding EDs
A new study testing the use of a high-sensitivity troponin protocol in both hospital and freestanding emergency departments (ED) found that freestanding EDs discharge patients at a much higher rate. Results from the RACE-IT (Rapid Acute Coronary Syndrome Exclusion using high-sensitivity I cardiac Troponin) study were published in Academic Emergency Medicine.[1]
"The study found that freestanding EDs demonstrated meaningful operational advantages when using the accelerated troponin pathway, including faster rule out and earlier discharge of low-risk chest pain patients, while maintaining comparable safety outcomes," lead author Satheesh Gunaga, DO, vice chair of emergency medicine and division head of EMS at Henry Ford Wyandotte Hospital, told Cardiovascular Business.
Freestanding emergency departments represent one of the fastest growing segments of emergency care in the United States, and patients presenting with chest pain and possible heart attacks makes up a sizable number of patient visits. However, there is not a lot of data on how modern cardiac diagnostic pathways perform in these outpatient settings.
High-sensitivity troponin testing protocols are used at many hospital emergency rooms to detect elevated tropic levels caused by tissue ischemia. These one-hour tests can replace traditional techniques that take several hours, allowing negative patients to be discharged much faster.
The study included 32,609 patients, of which 26,957 were assessed in one of five hospital EDs, and 5,652 in one of four freestanding EDs in the Henry Ford Health System in the Detroit area. The comparison found that a high-sensitivity troponin protocol performed similarly in both settings. It safely identified low-risk chest pain patients while maintaining comparable discharge and safety outcomes across care settings. However, a much higher percentage of patients were discharged faster at the freestanding EDs.
Safe discharge from hospitals occurred 53.7% of the time in the standard care arm that discharged patients if all troponin values were below the 99th percentile at 0 and 3 hours. The number decreased a little to 50.3% under the accelerated troponin protocol, which allowed patients to be discharged immediately if there was no troponin detected in the first test. Interestingly, safe discharge from a freestanding ED occurred at a much higher rate (86%) in the standard care arm, increasing to 95% under the accelerated protocol.
"Overall, the observed association between the accelerated protocol and safe discharge was stronger in freestanding EDs than in hospital EDs," Gunaga explained. "The analysis builds on the broader RACE-IT research program, which has shown that rapid high sensitivity troponin pathways can reduce cardiac testing, cardiology consultations and emergency department length of stay without increasing downstream revascularization rates."
He said as freestanding EDs expand nationally, these findings provide important validation that accelerated cardiac rule-out pathways can be implemented safely and effectively outside traditional hospital environments. The study cites a 2016 Medicare Payment Advisory Commission report that found freestanding EDs accounted for about 11% of the 5,200 EDs nationwide.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]