Thursday, April 28, 2005

Enhancing Cardiac Diagnosis and Treatment Capability with Automation and Laboratorian/Clinican Collaborations

Denise L. Uettwiller-Geiger, Peter Bruno, Joan Faro, Judith Mignone, and Owen Yen.

Physicians need fast, accurate test results if they're to make timely, appropriate treatment decisions for chest pain patients and save heart muscle. Time pressures also make it difficult for physicians to remember every cardiac test protocol/attribute, particularly as field changes.

Determine how hospital labs can improve turnaround time (TAT) and reliability of cardiac test results, and enhance clinicians' understanding/assessment of those results. Support clinicians by providing advanced assays and tools to help them utilize results appropriately.

· Design: Outcome, with continuous monitoring
· Setting: Clinical laboratory for 248-bed community hospital.
· Participants: Heart Team
· Intervention(s): Laboratory automation. Use of advanced cardiac assays: troponin I and for patients with non-ST elevation, ischemia-modified albumin. Formation of clinician/laboratorian “heart team” to implement best practices in cardiac care. Development of algorithms, check-off protocols, check-off test order sets, and informational tools to support clinicians in test ordering/interpretation and treatment.
· Main outcome measure(s): Process measures

Quantifiable: Post-automation, TAT for troponin I is now 49 minutes from verification to release to ED, 30 minutes less than pre-automation. Lab processes approximately 26,000 TnI tests per year, magnifying impact of minutes saved.
Non-quantified: More predictable TAT, creating better use of clinicians' time (little calling for results; initial interpretation accompanies lab results); better patient care. Reduced length-of-stay in ED. Improved diagnosis/treatment of patients. Increased respect for value of lab.

Lab automation is essential to service level clinicians require, making it possible to dramatically reduce results TAT, while delivering near-flawless accuracy.
Laboratorian/clinician collaborations enable labs to introduce advanced assays effectively and support clinicians in implementing cardiac best practices, including rapid and appropriate test ordering, test interpretation, and treatment.

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See more of The 2005 Institute for Quality in Laboratory Medicine Conference