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Doctor

Improving Emergency Care through
Faster Risk Stratification

You’re having - or have had -  chest discomfort, and you have decided to to call an ambulance or present to your local emergency department to ask a doctor "Am I having a heart attack?"

 

The question you have is the most common reason why patients present to hospitals in New Zealand

 

Your assessment will involve a number of tests that we can perform in the department, for example: blood pressure, heart rate and a heart tracing (ECG).

A blood test (Troponin) will be sent to the laboratory. The troponin test looks for injury to the heart. 

 

These tests are collectively required so that your doctor and team can make a decision if you are - or are not - having a heart attack.

 

This will lead to a care plan that is specific for you. 

I’m sure you are aware our emergency departments are becoming very busy places.

We know that when a doctor comes to speak with you and discuss why you have come to hospital, they need all the test information to be able to make a decision whether you are in fact having a heart attack.

 

This includes the troponin blood result from the laboratory, and this is usually available 60-90 minutes later. Your doctor will normally wait for that blood result before they can make a decision on your diagnosis and treatment.

 

While waiting for the blood result your doctor will continue to see other patients and may even get called away to a critically ill patient. The hospital team will continue to monitor you until your doctor can come back.

 

If the availability of the lab test result does not coincide with the doctor's availability to make a decision, this may mean you will wait longer to be treated or to be safely discharged home.

 

If there was a way for your doctor to have all the information they need at the time they first spoke to you, that would allow them to give you some reassurance, or a plan of what’s next.

 

What if we could perform the blood test right there in the emergency department, and the result was available to your doctor at the point they are ready to make a decision?

 

You may require the same blood test to be repeated in 2 hours which would mean another 90 minute wait afterwards. If the result was to be quickly available in the emergency department, this would safely speed up the decision to send you home or admit you to a ward in the hospital.

 

A project has been created to do exactly this.  Called 'ICare-FASTER', this project is led by Professor Martin Than, Consultant and Director of Research at the Emergency Department of Christchurch Hospital. 

 

Professor Than and the ICare-FASTER team aims to implement a blood test that is located in a hospital emergency department and is used alongside an existing chest pain pathway to deliver safe care when assessing if a patient is having a heart attack.

 

This will mean that your doctor and team will have a result within 8 minutes (vs 90min) of the test being started and - most importantly - your doctor will have that information when they assess you.

 

By improving the efficiency of having the right information at the right time, we hope to show a reduction in time that patients like you spend in the emergency department.

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