Info

ED diagnostic performance

ED clinical impact

Quality Accuracy

Quality

evidence (max = + + +)

of evidence Impact

A + + +

A + + +

Two published early trials have shown impact on the speed and accuracy of ED triage (66,68). The trial of clinical impact on ED triage decision making of a 10,689-patient multicenter controlled clinical trial showed the diagnostic performance of the ACI-TIPI electrocardiograph by itself and by ACI-TIPI risk groups to be very good and showed that its use improved patient ED triage (69). In terms of its actual impact on ED care, for patients without ACI in hospitals with low telemetry capacities, the use of the ACI-TIPI decreased CCU admissions by 16% and increased ED discharges to home by 7% (p = 0.09). Moreover, for patients seen by residents without supervising attending physicians, the ACI-TIPI's use reduced CCU admissions by 31%, reduced telemetry admissions by 19%, and increased discharged to home by 18% (p = 0.005).

For patients with stable angina pectoris, in hospitals with low telemetry bed capacities, the ED use of the ACI-TIPI reduced CCU admission by 50%, increased telemetry admissions by 25%, and increased ED discharges to home by 10% (p = 0.04). At hospitals with high telemetry capacities, the use of the ACI-TIPI reduced telemetry admissions by 14% and increased ED discharges to home by 101% (p = 0.03) (the level of discharge seen in hospitals with lower telemetry unit capacities). Across all hospitals, the ACI-TIPI reduced CCU admission by 26% and increased ED discharges to home by 48% (p = 0.04). Finally, for patients with AMI or UAP, at both the low- and high-capacity hospitals, and with both supervised and unsupervised residents, the ACI-TIPI's ED use did not change the appropriate admission of 96% of patients to either CCU or telemetry beds.

The overall results of the Systematic Review's final ratings of the quality of evidence evaluating this technology and of its ED diagnostic performance and clinical impact are shown in Table 6.

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