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Chest Pain Unit Using Thrombolysis in Myocardial Infarction Score Risk Stratification: An Impact on the Length of Stay and Cost Savings

Shah, Priyank P. MD*; Gupta, Nishant MD; Sharma, Anurag MD*; Bhargava, Rishi K. MD*; Bajaj, Sharad MD; Mittal, Vipin MD*; Johnson, Cynthia MBA; Shamoon, Fayez MD§; Bikkina, Mahesh MD

Critical Pathways in Cardiology: December 2012 - Volume 11 - Issue 4 - p 206–210
doi: 10.1097/HPC.0b013e31826cc254
Original Articles

Background: Despite the fact that studies have demonstrated cost-effectiveness of chest pain observation units (CPOUs) in emergency departments, they have not been widely implemented. Thrombolysis in Myocardial Infarction (TIMI) score is an easy and reliable tool, but none of the prior studies have used it for risk stratification in CPOUs. We propose to study the impact of CPOU using TIMI risk stratification model on the length of stay (LOS) and cost savings.

Methods: We studied 777 patients with chest pain admitted to our hospital from July 2010 to June 2011. The patients with a TIMI score of 0 to 2 were observed for 12 hours, those with a score of 3 to 4 were observed for 20 hours, and the ones with a score >4 were deemed appropriate for admission. We calculated the cost differences between the actual admissions and the CPOU.

Results: A total of 39.1% of patients had a TIMI score of 0, 31.1% had a TIMI score of 1, 18.1% had a TIMI score of 2, 9.2% and 2.5% had TIMI scores of 3 and 4, respectively. The expected LOS based on this model was 418.5 days versus the actual LOS of 1324 days. The cost of CPOU was estimated to be $1,979,977. However, the actual cost was $3,216,809. Hence, the annual cost savings were estimated to be $1,236,832.

Conclusion: CPOU using TIMI score is an easy and reliable risk stratification tool for patients with chest pain in the emergency department and can significantly reduce the LOS, hence saving millions of dollars in this economic crisis.

From the Departments of *Internal Medicine and Cardiology, St. Joseph’s Regional Medical Center, Paterson, NJ; and the Departments of Business Administration and §Cardiology, St. Michael’s Medical Center, Newark, NJ.

Reprints: Priyank P. Shah, MD, St. Joseph’s Regional Medical Center, 703 Main Street, Paterson NJ 07503. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.