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 and 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: 1-11. doi:10.1136/bmjopen-2015-009746

Author Cheng, Qinglu
Greenslade, Jaimi H.
Parsonage, William A.
Barnett, Adrian G.
Merollini, Katharina
Graves, Nicholas
Peacock, W. Frank
Cullen, Louise
Title Change to costs and lengths of stay in the emergency department and the Brisbane protocol: an observational study
Journal name BMJ Open   Check publisher's open access policy
ISSN 2044-6055
Publication date 2016
Year available 2016
Sub-type Article (original research)
DOI 10.1136/bmjopen-2015-009746
Open Access Status DOI
Volume 6
Issue 2
Start page 1
End page 11
Total pages 11
Place of publication London, United Kingdom
Publisher BMJ Publishing Group
Collection year 2017
Language eng
Formatted abstract
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.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
Admin Only - School of Medicine
School of Medicine Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 0 times in Thomson Reuters Web of Science Article
Scopus Citation Count Cited 0 times in Scopus Article
Google Scholar Search Google Scholar
Created: Tue, 22 Mar 2016, 01:28:23 EST by System User on behalf of School of Medicine