Addressing the Critical Concerns of the Emergency Department (ED)
EDs are facing unprecedented challenges
Across the country, EDs are experiencing overcrowding,1 with the number of patients using emergency care rising as the number of facilities to treat them is decreasing. Consequences of overcrowding include prolonged patient pain and suffering, leaving without seeing a physician, treatment delays for time-sensitive illnesses, and patient dissatisfaction with care.2 Reduced facility availability combined with the demand for care has led to extensive wait times, with patients waiting an average of 55.8 minutes to see a physician for emergency care.3 In 2006, 30% of visits to the ED lasted 4 hours or more.3 Excessive waiting time can further delay treatment.
At the same time as EDs are experiencing increased need for emergency care, further operational demands are being placed on them, such as the need for increased system efficiency, and a role in supporting quality/compliance initiatives. Emergency departments are being pressured by guidelines specifying accelerated evaluation for patients presenting with specific complaints, including fever, chest pain, and abdominal pain. Added time pressure is being imposed in an environment of limited resources and financial constraints. All of these factors make choosing a point-of-care testing platform that will meet the needs of both the hospital and a diverse patient population critically important.
The i-STAT System Provides Lab-Quality Blood Testing Results in Minutes
With the industry's most comprehensive menu of tests in a single platform, the i-STAT System is at the forefront of expanding the technology driving bedside point-of-care testing in EDs, helping to expedite the treatment of patients in the hospital and beyond. This comprehensive menu of tests gives hospitals the flexibility to expand with their growing clinical initiatives.
In clinical trials, the i-STAT System has been shown to:
- Expedite patient triage by accelerating the availability of critical diagnostic test information5
- Improve patient flow, shorten door-to-disposition times, and reduce overall ED length of stay4,5
- Provide lab-quality blood testing results in minutes,6 which can accelerate patient care decision-making and expedite time to treatment, when every minute counts
- Support hospitals in maintaining compliance with evidence-based guidelines4
The most common tests for your most common ED patients
Another key benefit of the i-STAT handheld analyzer is the comprehensive menu of test cartridges, including those most commonly used in the ED.
The i-STAT BNP test is an in vitro diagnostic test for the quantitative measurement of B-type natriuretic peptide (BNP) in whole blood or plasma samples using EDTA as the anticoagulant. BNP measurements can be used as an aid in the diagnosis and assessment of the severity of congestive heart failure.
The i-STAT cTnI test is an in vitro diagnostic test for the quantitative measurement of cardiac troponin I (cTnI) in whole blood or plasma samples. Measurements of cardiac troponin I are used in the diagnosis and treatment of myocardial infarction and as an aid in the risk stratification of patients with acute coronary syndromes with respect to their relative risk of mortality.
The i-STAT PT, a prothrombin time test, is useful for monitoring patients receiving oral anticoagulation therapy such as Coumadin or warfarin.
The i-STAT System also offers an easy-to-use testing process that significantly streamlines the complexity of traditional lab processing and improves financial outcomes by increasing efficiencies in the ED and throughout the hospital.8
Four Easy Steps to Getting Important Results
- Apply a few drops of blood
- Insert cartridge
- Results within minutes
- Automatic upload to patient chart
Explore how the i-STAT System can accelerate decision making for patients with chest pain.
Case in Point: Chest Pain—Read more about the i-STAT’s use in the Emergency Department
In the United States, approximately 6% of all adult patients presenting in the ED have a chief complaint of chest pain, which is the second most common reason a patient visits the ED.3 For every minute a heart attack goes undiagnosed, significant myocardial tissue may be lost. However, patients with chest pain require lengthy, complex testing procedures that have the potential to considerably increase time to diagnosis, as well as decrease throughput within the ED.
Evidence-based guidelines state that cardiac troponin is the biomarker of choice for the diagnosis of myocardial infarction and is the preferred marker for risk stratification of possible ACS patients.7 Therefore, measurement of more than one specific biomarker of myocardial necrosis is not necessary and is not recommended.7 The time from physician order to available results should be 60 minutes or less, preferably less than 30 minutes.4 In fact, the Society of Chest Pain Centers recommends troponin results be available to the physician 30 minutes after patient arrival to the ED for Cycle III Chest Pain Center Accreditation. If these guidelines are not attainable by the central laboratory, quantitative point-of-care testing should be considered.4
Point-of-care testing with the i-STAT System has been proven to accelerate troponin turnaround time (TAT). In the largest randomized controlled clinical trial to date evaluating the impact of bedside point-of-care testing, the DISPO-ACS trial, the i-STAT® System met the 60-minute TAT guideline 98% of the time compared to 53% for the central laboratory, and met the 30-minute TAT 87% of the time compared to only 3% for the central lab. 2 In addition, the DISPO-ACS trial showed that the i-STAT System helped facilitate early serial cardiac marker testing at one facility.2
When time is of the essence, patient point-of-care testing with the i-STAT System can accelerate patient care decision-making. In clinical trials, the i-STAT System has been shown to:
- Expedite patient triage by accelerating the availability of critical diagnostic test information
- Improve patient flow and reduce overall length of stay2-3
- Support hospitals in maintaining compliance with evidence-based guidelines
Critical Care
References
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- Committee on the Future of Emergency Care in the United States Health System. Hospital-Based Emergency Care: At the Breaking Point. Washington, DC; 2007; The National Academies Press. Future of Emergency Care Series.
- Wilper AP, Woolhandler S, Lasser KE, McCormick D, Cutrona SL, Bor DH, Himmelstein DU. Waits to see an emergency department physician: U.S. trends and predictors, 1997-2004. Health Aff (Millwood). 2008;27(2):w84-95.
- Pitts SR, Niska RW. Xu J, et al. National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary. Natl Health Stat Rep. 2008;7:1-40.
- Ryan RJ, Lindsell CJ, Hollander JE, et al. A multicenter randomized controlled trial comparing central laboratory and point-of-care cardiac marker testing strategies: The Disposition Impacted by Serial Point of Care Markers in Acute Coronary Syndromes (DISPO-ACS) Trial. Ann Emerg Med. 2008 Aug 6. (Epub ahead of print).
- Hsiao AL, Santucci KA, Dziura J, et al. A randomized trial to assess the efficacy of point-of-care testing in decreasing length of stay in a pediatric emergency department. Ped Emer Care. 2007;7:457-462.
- Apple FS, Murakami MM, Christenson RH, et al. Analytical performance of the i-STAT® cardiac troponin I assay. Clin Chim Acta. 2004;345:123-127.
- Ryan R, Lindsell C, Hollander J, et al. Disposition impacted by serial point-of-care markers in ACS (DISPO-ACS): a multicenter randomized controlled trial comparing central laboratory and point-of-care marker testing strategies. Acad Emerg Med. 2007;14(5 suppl 1):S130-131.
- Bailey TM, Topham TM, Wantz S, et al. Laboratory process improvement through point-of-care testing. Jt Comm J Qual Improv. 1997;23:362-380.