Redesigning the diagnostic pathway for chest pain patients in emergency departments
dc.contributor.author | Rachuba, S | |
dc.contributor.author | Salmon, A | |
dc.contributor.author | Zhelev, Z | |
dc.contributor.author | Pitt, M | |
dc.date.accessioned | 2017-06-09T12:20:39Z | |
dc.date.issued | 2017-03-30 | |
dc.description.abstract | Patients presenting with chest pain at an emergency department in the United Kingdom receive troponin tests to assess the likelihood of an acute myocardial infarction (AMI). Until recently, serial testing with two blood samples separated by at least six hours was necessary in order to analyse the change in troponin levels over time. New high-sensitivity troponin tests, however, allow the inter-test time to be shortened from six to three hours. Recent evidence also suggests that the new generation of troponin tests can be used to rule out AMI on the basis of a single test if patients at low risk of AMI present with very low cardiac troponin levels more than three hours after onset of worst pain. This paper presents a discrete event simulation model to assess the likely impact on the number of hospital admissions if emergency departments adopt strategies for serial and single testing based on the use of high-sensitivity troponin. Data sets from acute trusts in the South West of England are used to quantify the resulting benefits. | en_GB |
dc.description.sponsorship | This publication is based on a project funded by the South West Academic Health Science Network (SW AHSN). The work of the authors is also funded by the National Institute for Health (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the SW AHSN or the Department of Health. | en_GB |
dc.identifier.citation | Published online 30 March 2017 | en_GB |
dc.identifier.doi | 10.1007/s10729-017-9398-2 | |
dc.identifier.uri | http://hdl.handle.net/10871/27911 | |
dc.language.iso | en | en_GB |
dc.publisher | Wiley for British Society for Immunology | en_GB |
dc.relation.url | https://www.ncbi.nlm.nih.gov/pubmed/28361346 | en_GB |
dc.rights | © The Author(s) 2017. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. | en_GB |
dc.subject | Avoidable admissions | en_GB |
dc.subject | Case study | en_GB |
dc.subject | Chest pain | en_GB |
dc.subject | Diagnostic pathways | en_GB |
dc.subject | Discrete event simulation | en_GB |
dc.subject | Emergency department | en_GB |
dc.title | Redesigning the diagnostic pathway for chest pain patients in emergency departments | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2017-06-09T12:20:39Z | |
dc.identifier.issn | 1386-9620 | |
exeter.place-of-publication | Netherlands | en_GB |
dc.description | This is the final version of the article. Available from Wiley via the DOI in this record. | en_GB |
dc.identifier.journal | Health Care Management Science | en_GB |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ |
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Except where otherwise noted, this item's licence is described as © The Author(s) 2017. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.