Telemedicine Rapid Assessment in the Emergency Department: A Pilot Study

ObjectiveTo estimate the cost implications of early angiography for patients with suspected non-ST elevation acute coronary syndrome (NSTEACS) using tissue Doppler imaging (TDI).DesignA decision tree model was used to synthesise data from the pilot study and literature sources. Sensitivity analyses tested the impact of assumptions incorporated into the analysis.SettingEmergency department (ED), Brisbane, Australia.ParticipantsPatients with suspected NSTEACS.InterventionsTDI as a diagnostic tool for triaging patients within 4 hours of presentation in addition to conventional risk stratification, compared with conventional risk stratification alone.Data sourcesResource used for diagnosis and management were recorded prospectively and costed for 51 adults who had echocardiography within 24 hours of admission. Costs for conventional care were based on observed data. Cost estimates for the TDI intervention assumed patients classified as high risk at TDI (E/e’>14) progressed early to angiography with an associated 1-day reduction in length of stay.Primary outcome measuresCosts until discharge from the Australian healthcare perspective in 2016–2017 prices.ResultsFindings suggest that using TDI as a diagnostic tool for triaging patients with suspected NSTEACS is likely to be cost saving by $A1090 (95% credible interval: $A573 to $A1703) per patient compared with conventional care. The results are mainly driven by the assumed reduction in length of stay due to the inclusion of early TDI in clinical decision-making.ConclusionsThis pilot study indicates that compared with conventional risk stratification, triaging patients presenting with suspected NSTEACS with TDI within 4 hours of ED presentation has potential cost savings. Findings assume a reduction in hospital stay is achieved for patients considered to be high risk at TDI. Larger, comparative studies with longer follow-up are needed to confirm the clinical effectiveness of TDI as a diagnostic strategy for NSTEACS, the assumed reduction in hospital stay and any cost saving.

Download Full-text

Lactate levels as a marker of tissue hypoperfusion in acute heart failure patients seen in the emergency department: a pilot study

Emergency Care Journal ◽

10.4081/ecj.2016.5458 ◽

2016 ◽

Vol 1 (1) ◽

Author(s):

Kori Sauser ◽

Lora Alkhawam ◽

Linda Pierchala ◽

Peter S. Pang

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Pilot Study ◽

Acute Heart Failure ◽

Tissue Ischemia ◽

Tissue Hypoperfusion ◽

Baseline Characteristics ◽

Lactate Levels ◽

Elevated Lactate ◽

Mean Heart Rate

Acute heart failure (AHF) may lead to subclinical tissue ischemia due to hypoperfusion from inadequate forward flow or congestion. The aim of the present study is to test whether lactate levels are elevated in emergency department (ED) patients with AHF. A prospective pilot study of ED AHF patients was conducted. Venous lactate level was measured at baseline and 6-12 hours after initial draw. Of the 50 patients enrolled, mean age was 65.3 years, 68% were male. Only 7 (14%) had an elevated lactate on either draw, with no differences in baseline characteristics between patients with and without elevated lactate. Patients with an elevated lactate had a higher mean heart rate (99 <em>vs</em> 81, P=0.03) and trended toward an increased rate of abnormal initial temperature (57 <em>vs</em> 23%, P=0.06). In this pilot study, only a minority of acute HF patients had an elevated lactate on presentation.

Download Full-text