Impact of CK-MB testing policies on hospital length of stay and laboratory costs for patients with myocardial infarction or chest pain

Abstract

We obtained data on hospital length of stay (LOS) and total laboratory charges for Medicare patients admitted to 82 hospitals in Massachusetts during 1994. Five Diagnosis Related Groups (DRGs) were selected: surviving acute myocardial infarction (AMI) with, and without, complications; AMI with death; angina pectoris; and chest pain. The hospitals were grouped according to their laboratory policies for testing CK-MB (e.g., frequency of assay runs; information obtained by telephone survey). The study was conducted to determine whether there was an association between turnaround times for results and LOS for cardiac DRGs. The mean LOS for AMIs with complication for 1513 patients admitted to 22 hospitals whose laboratories perform CK-MB testing once or twice daily was 8.4 days [95% confidence interval (CI): 8.2- 8.7]. In contrast, the mean LOS for hospitals with CK-MB test policies of at least 3 runs daily or random-access stat was significantly (P <0.051 lower, 7.7 days (CI: 7.4-8.0 and 7.5-7.9, respectively). Overall laboratory charges were lower in the hospitals with shorter LOS. With one exception, there was no significant difference in LOS between patients with DRGs of angina pectoris or chest pain or other AMI DRGs. For AMI, a CK-MB testing policy that produces shorter turnaround times may be justified because of an association with reductions in LOS and overall laboratory costs.