Rapid recognition of myocardial infarction is associated with improved outcomes. Guidelines for troponin testing have recommended troponin result availability within 60 minutes of physician order.
Evaluate efficacy of process improvement on rapid availability of troponin to make results consistently available within 60 minutes.
Design – Prospective monitoring of times from arrival in the emergency room to physician order, sample collection, laboratory delivery, and result availability in 1472 consecutive patients seen after process improvement, compared to retrospective review of 300 consecutive patients seen before intervention.
Setting – Emergency room of an urban, Veterans Affairs Medical Center, with central laboratory testing (using the Beckman-Coulter Access 2 analyzer) and no automated system for laboratory sample delivery.
Participants - Consecutive patients with suspected acute myocardial infarction seen over 9 months.
Intervention – Process improvement team altered procedures for sample transport and laboratory processing based on analysis of baseline performance.
Main outcome measures – Time from order to lab arrival and result completion, percent of troponin results completed within specified times (45 minutes, 60 mintues).
At baseline, the median total time from physician order to test completion and reporting was 91 minutes. Median time from order to laboratory arrival decreased from 45 to 12 minutes, and median laboratory processing time decreased from 45 to 24 minutes. Median time from order to completion decreased from 91 minutes to 37 minutes; 96% of tests were completed within 1 hour of order (compared to 15% at baseline), and 87% were completed within 45 minutes (compared to 3% at baseline).
Even with central laboratory testing, improvements in process can produce acceptable turnaround time for troponin measurements, similar to those achieved with point of care testing.
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