Emergency Cardiac Biomarkers and Point-of-Care Testing

Abstract

IntroductionThe goals of this paper are a) to facilitate the efficient diagnosis of patients who present with episodes of acute chest pain in rural emergency rooms located in low-resource community hospitals, b) to systematically optimize point-of-care (POC) testing using small-world networks (SWNs) adapted to unique and challenging geographic settings, and c) to align POC cardiac biomaker testing with referral options and treatment modalities available to local emergency medicine nurses and physicians. Methods Field SurveysField surveys focused primarily on a) cardiac biomarker testing and related cardiology and emergency medical system (EMS) services (Figure 1), b) point-of-care testing (POCT) resources and competency levels, and c) healthcare delivery systems within and between provinces in Isaan, northeastern Thailand. We visited and surveyed on site 3 referral hospitals Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. in Khon Kaen City, 5 province regional hospitals (RHs), and 10 community hospitals (CHs) administered by the Thai government in 6 provinces (Tables 1 and 2). NIH Public Access Response RateThe research process was developed carefully during prior field surveys in Sakaeo Province as part of Fulbright-sponsored research 1-3 and subsequently improved for several other regions of Thailand 4 and the United States 5 . Most POCT and clinical laboratory equipment was photo documented. Live interviews and telephone follow-up yielded a 100% return rate on survey questions, which included needs assessment. On-Site InterviewsInterviews were conducted in the Thai language. At each site a defined list of questions ("short form") was used to structure data gathered for consistency during discussions with hospital administrators, clinical directors, physicians, nurses, EMS personnel, ambulance drivers, laboratory technologists, and other staff in CHs and RHs. Additionally, we investigated Primary Care Units (PCUs) in follow-up. DemographyFrom on-site interviews, we collected health demography facts about each medical site, such as the number of hospital beds, numbers and types of physicians, the status of critical care units (e.g., ICU, CCU, OR, and ER), and the impact of patients with acute coronary syndrome (ACS) and acute myocardial infarction (AMI) on emergency services. National databases were consulted for population and health resources data 6-8.Province populations, PCUs, beds, physicians, professional nurses, technical nurses, and pharmacists were 977508, 157, 1105, 104, 898, 155, and 73 for Kalasin; 1752414, 146, 3748, 540, 2915, 454, and 212 for Khon Kaen; 9...

Evidence-based point-of-care tests and device designs for disaster preparedness

“…Emerging technologies can be properly integrated at the local level through small-world networks to ensure appropriate regional coordination and competent use from frequent practice. 28,29 …”

Enhancing crisis standards of care using innovative point-of-care testing

“…The advantage of the SWN-POC approach is that local community and regional healthcare leaders can blend preparedness synergistically with routine daily use of POC testing to fulfill both disaster needs and emergency medicine goals within the SWN (Figure 5). 27 …”

“…We envision implementing POC testing within “small-world networks” (SWNs), 27,34 which are comprised of the regional health care delivery systems, nodal placement sites for POC testing, and established EMS transport modalities and routes. Small-world networks facilitate daily use of POC testing, so that preparedness is community-based and in place daily, ordinary urgent care and emergency services are served, health professional are practiced at delivering POC test results at the bedside, and the total scheme is medically sound (Table 4).…”

Assessing Point-of-Care Device Specifications and Needs for Pathogen Detection in Emergencies and Disasters

“…Disaster response sites could be set up as small-world networks 21 with each node containing time critical POC testing and connecting to an alternate care facility or community hospital with the ability to perform tests that require limited resources.…”

“…Emergency and disaster response networks, modeled on naturally occurring small-world networks, 21 can be used to help create plans to carefully educate POC operators, such as ambulance emergency personnel.…”