Change to costs and lengths of stay in the emergency department and the Brisbane protocol: An observational study

Cheng, Qinglu, Greenslade, Jaimi H., Parsonage, William A., Barnett, Adrian G., Merollini, Katharina, Graves, Nicholas, Peacock, W. Frank, & Cullen, Louise (2016) Change to costs and lengths of stay in the emergency department and the Brisbane protocol: An observational study. BMJ Open, 6(2), Article Number:-e009746.

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  • Objective

To compare health service cost and length of stay between a traditional and an accelerated diagnostic approach to assess acute coronary syndromes (ACS) among patients who presented to the emergency department (ED) of a large tertiary hospital in Australia.

  • Design, setting and participants

This historically controlled study analysed data collected from two independent patient cohorts presenting to the ED with potential ACS. The first cohort of 938 patients was recruited in 2008–2010, and these patients were assessed using the traditional diagnostic approach detailed in the national guideline. The second cohort of 921 patients was recruited in 2011–2013 and was assessed with the accelerated diagnostic approach named the Brisbane protocol. The Brisbane protocol applied early serial troponin testing for patients at 0 and 2 h after presentation to ED, in comparison with 0 and 6 h testing in traditional assessment process. The Brisbane protocol also defined a low-risk group of patients in whom no objective testing was performed. A decision tree model was used to compare the expected cost and length of stay in hospital between two approaches. Probabilistic sensitivity analysis was used to account for model uncertainty.

  • Results

Compared with the traditional diagnostic approach, the Brisbane protocol was associated with reduced expected cost of $1229 (95% CI −$1266 to $5122) and reduced expected length of stay of 26 h (95% CI −14 to 136 h). The Brisbane protocol allowed physicians to discharge a higher proportion of low-risk and intermediate-risk patients from ED within 4 h (72% vs 51%). Results from sensitivity analysis suggested the Brisbane protocol had a high chance of being cost-saving and time-saving.

  • Conclusions

This study provides some evidence of cost savings from a decision to adopt the Brisbane protocol. Benefits would arise for the hospital and for patients and their families.

Impact and interest:

2 citations in Scopus
1 citations in Web of Science®
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ID Code: 93354
Item Type: Journal Article
Refereed: Yes
Keywords: emergency department, acute coronary syndrome, chest pain, cost analysis, length of stay
DOI: 10.1136/bmjopen-2015-009746
ISSN: 2044-6055
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PUBLIC HEALTH AND HEALTH SERVICES (111700)
Australian and New Zealand Standard Research Classification > ECONOMICS (140000) > APPLIED ECONOMICS (140200) > Health Economics (140208)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Public Health & Social Work
Copyright Owner: Copyright 2016 The Author(s)
Copyright Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Deposited On: 03 Mar 2016 00:06
Last Modified: 03 Mar 2016 22:08

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