Chest pain centers risk management and customer satisfaction

The largest dollar amount for liability recovery still involves chest pain with subsequent missed transmural MI [141]. Rather than treating patients in their offices, more physicians refer patients to EDs, and high-risk specialists progressively become unwilling to provide ED on-call coverage because of malpractice concerns and skyrocketing premiums [142]. Efficiency mandates that chest pain centers should use prompt rule-out schemes and that rapid cardiac biomarker testing should be performed (along with rapid EKG) to help physicians avoid missing patients who present with AMI, currently estimated to occur in 2% to 5% [109,143,144]. Chest pain centers that adopt a macroscopic viewpoint, aggressive leadership, and legal precautions generate excellent community relations and customer satisfaction [145]. Experience in legal case analysis has revealed patients were sent home before clinical laboratory results became available, only to discover too late an elevated cTnI or CK-MB. Also, physicians may order cardiac biomarker tests for which blood collection is delayed, and attend to other patients or leave the area, thereby inadvertently overlooking important results. POCT and ''physician capture'' [2] can help alleviate these types of errors and simultaneously provide other critical test results necessary for patient evaluation and triaging.

To reduce risk exposure each institution should identify bottlenecks in cardiac critical pathways and then determine specifically if cardiac biomarker POCT can accelerate evaluation and therapy. TTAT actually achieved not only should meet ACS/AHA guidelines but also should satisfy the current standard of care for rapid response testing of patients with life-threatening conditions. Table 1 includes tests (other than cardiac biomarkers) that are available on the same platforms. These other tests can help physicians synthesize critical care solutions [2,3]. For example, clinicians evaluating acutely ill patients who present with chest pain can order electrolyte measurements, such as potassium (K+) and ionized calcium (Ca++), and these analytes, already available on several POC platforms (possibly the same ones that perform cardiac biomarker testing), can be integrated increasingly as market demand and manufacturing efficiencies drive instrument consolidation in the cardiac biomarker field.

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