Simulating single test rule-out strategies for chest pain patients at emergency departments

Patients presenting with chest pain at an emergency department (ED) in the UK receive troponin tests to assess the likelihood of an acute myocardial infarction (AMI). Until recently, two blood samples separated by at least six hours were necessary to analyse the change of troponin levels over time. New high-sensitivity troponin tests may allow rule-out of AMI on the basis of a single test if the first blood sample is taken at least three hours after onset of the worst pain. This paper presents a discrete event simulation model which shows the likely impact on the numbers of hospital admissions to short stay wards if emergency departments adopted a single test rule-out strategy based on the use of high-sensitivity troponin tests. Data sets from acute trusts in the South West of the UK are used to quantify the resulting benefits.