Impact of a Decision Rule on duration of Continuous Cardiac Monitoring of Patients with Suspected Acute Coronary Syndrome in an Emergency Department.
Intern Med J. 2013 Jul 22;
Authors: King G, Nicholls GM, Jones P
OBJECTIVES: To determine the effect of introducing a decision rule on the duration of continuous cardiac monitoring (CCM) for patients with suspected acute coronary syndrome (ACS) in an adult emergency department (ED).
METHODS: This was a retrospective observational study of 220 patients with suspected ACS made up of two consecutive cohorts collected before and after introduction in July 2010 of a decision rule that made use of a new hsTnT assay. The primary outcome was median CCM duration in the ED (CCMED). Secondary outcomes were median duration of CCM in the first 24 hours (CCM24), rate of adverse events, proportion of patients after the intervention who had the rule adhered to and estimated median CCMED had the decision rule been adhered to by all patients.
RESULTS: The decision rule was adhered to in 59.3% (95%CI 49.8-68.1) of patients post intervention. There was no statistically or clinically significant difference in median CCMED before (240min, IQR 156-313) and after (230min IQR 145-353) introduction of the decision rule (p= 0.74), nor in CCM24 (908min vs. 929min). Seven (3.2%, 95% CI 1.4-6.6) adverse events occurred overall. All three patients with adverse events after the intervention were monitored in ED according to the decision rule.
CONCLUSION: Introduction of this decision rule did not decrease the median CCMED. All adverse events after the intervention occurred in appropriately monitored patients, including patients with initially negative hsTnT, suggesting that the decision rule would not compromise patient safety.
PMID: 23869547 [PubMed - as supplied by publisher]