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The study, entitled A Multicenter Randomized Controlled Trial ComparingCentral Laboratory and Point-of-Care Cardiac Market Testing Strategies: TheDisposition Impacted by Serial Point of Care Markers in Acute CoronarySyndromes Trial (DISPO-ACS), is the first-ever randomized controlled clinicaltrial directly evaluating the impact of patient side point-of-care testing on2,000 patients with chest pain, or possible acute coronary syndrome (ACS), onthe length of stay in the emergency department (ED). It was led by RichardRyan, M.D., vice chairman, Department of Emergency Medicine at the Universityof Cincinnati College of Medicine. The four EDs involved in the study are TheJewish Hospital in Cincinnati, William Beaumont Hospitals in Detroit, theUniversity of Pennsylvania, and Stanford University.
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"For patients presenting with chest pain, rapid diagnosis and theinitiation of treatment can mean the difference between life and death,"according to Dr. Ryan. "Ask yourself this question, 'Would I rather wait morethan an hour to find out if I was having a heart attack or would I want toknow in 15 minutes?' The answer 100 percent of the time would be 'the soonerthe better, for my heart, my health, my life.' For these reasons, the studyfindings are very significant," he said.
The study results also illustrate conclusively that patient sidepoint-of-care testing beats the turnaround time (the time between the drawingof a blood sample and the receipt of test result) of less than 60 minutesrecommended by the American Heart Association, American College of Cardiology,European Society of Cardiology and the National Academy of ClinicalBiochemistry's treatment guidelines. The preferred turnaround time, accordingto the guidelines, is less than 30 minutes.
The patient side point-of-care testing in this study was conducted usingthe Abbott i-STAT(R) System, an advanced, handheld, diagnostic tool thatprovides real-time lab-quality results within minutes to accelerate thepatient care decision-making process.
"The i-STAT results got to the doctor an average of 45 minutes faster thanthe lab results, and that's a lot of time when heart muscle is dying," saidChristopher J. Lindsell, Ph.D., University of Cincinnati Medical Center and astudy investigator. "This is why i-STAT patient side point-of-care testingdemonstrated a trend toward reducing length of stay in the ED for bothadmitted and discharged patients."
Patient side point-of-care testing with i-STAT Troponin, which is used tohelp diagnose a heart attack, beats the 60-minute recommended turnaround time98 percent of the time, compared to 53 percent for standard lab testing.Moreover, patient side point-of-care testing with i-STAT Troponin beats thepreferred 30-minute turnaround time 87 percent of the time, compared to 3percent for standard lab testing.
In addition to the benefits to patient care, i-STAT point-of-care testingwith troponin contributed to as much as a 20-minute reduction in overalllength of stay for some patients presenting in the ED with chest pain. Thestudy authors concluded that based on such results, an additional 60 hours permonth in ED bed availability could be realized in a facility that averaged aminimum of four chest pain patients per day.
The study also noted that when implemented as one of the key components ofan overall process improvement strategy, patient side point-of-care testingwith the i-STAT System can positively impact the overall efficiency of an ED'ssy
