If it hasn’t happened already, how your ED rules out myocardial infarction (MI) in chest pain patients is likely to change dramatically.

In a new report, researchers have deemed the high-sensitivity blood test for cardiac troponin safe and effective for use in EDs. The key advantage was that clinicians had the results much more quickly than conventional methods. Researchers developed a procedure for assessing the results of the new test, comparing it to a conventional troponin test, which takes three hours to complete.

The team conducted an observational study of 536 patients at the Parkland Health and Hospital System ED who were undergoing MI rule-out between August and October 2017. Sixty percent of patients presented with chest pain, 16% complained of shortness of breath, and 24% offered other complaints. No one exhibited ST elevations on ECG.

Participants were classified into two groups: “ruled out” or “abnormal,” based on high-sensitivity troponin test levels and change values. Researchers reported that the new procedure ruled out 30% of patients immediately and an additional 25% at one hour. By three hours high-sensitivity troponin tests ruled out heart attack in 83.8% of patients vs. 80.4% using the conventional test.

The authors concluded that the “early rule-out protocol appears safe, with a sensitivity and negative predictive value of 100%.”

For more information about this test and its application in the ED, be sure to read about it in the June 2018 issue of ED Management.

ED and Outpatient Services: CoPs and Proposed Changes

This two-part webinar series will cover the CMS Emergency Department and Outpatient CoPs and proposed changes. The first part will review CoPs requirements ED staff must know: EMTALA, restraint and seclusion, grievances, fundamental protocols, staffing, provision of services both on and off-campus, standards of care, medical director, and policies and procedures.