Case Studies

Impact of Point-of-Care TRoponin testing on ED throughput and staff satisfaction

The benefits of POC troponin testing on ED and laboratory efficiency, ED length of stay (LOS), and staff satisfaction were evaluated at Memorial Hospital Central*, a part of Memorial Health System in Colorado Springs, CO. At the time of the study, Memorial Hospital Central had a 68-bed ED with an annual census of 105,000 visits. Investigators implemented a serial POC troponin testing protocol at the bedside for patients presenting to the ED with chest, abdominal, or shoulder pain, and for whom a cardiac troponin test was indicated as part of the clinical workup. 

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To compare the impact of POC testing, investigators assessed:

  • Door-to-troponin Result time | Time from ED arrival to completion of troponin testing
  • ED LOS | Time from ED arrival to discharge from ED
  • nurse satisfaction | staff productivity and communication
  • TAT for non-troponin tests analyzed in the central lab | Time from receipt of sample by lab to completion of test

*The results shown here are specific to this health care facility and may differ from those achieved by other institutions.

with-patient solutions

 

Before POC testing, blood analysis for suspected ACS patients was performed by the central laboratory and included a cardiac marker panel (troponin, creatine kinase-MB [CK-MB], and myoglobin), a basic metabolic panel (BMP), and a complete blood count (CBC). This study evaluated the impact of moving to a single cardiac biomarker workflow using the i-STAT cTnI test from Abbott Point of Care.

Door-to-troponin Result time


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ED LOS**



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NURSING agreement on ed workflow improvement

100%1

Non-troponin TAT



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**avg. LOS of 290 mins. pre-i-STAT implementation vs. 255 mins. post-i-STAT implementation | Although demonstrating a lower trend, the change did not reach statistical significance

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Conclusion

Introduction of POC troponin testing in the ED can help institutions reduce door-to-troponin result times and ED LOS. Establishing a multidisciplinary team that included leaders and clinicians from the central laboratory and the ED was key to the successful implementation of POC testing at Memorial Hospital Central. In addition, ED staff satisfaction with POC testing was high, supporting the benefits of POC testing on improved patient flow, quality of care, and employee productivity.

1. Koehler, Jeanniline, BS et al. Effect of Troponin I Point-of-Care Testing on Emergency Department Throughput Measures and Staff Satisfaction. Advanced Emergency Nursing Journal. July–September 2013. Volume 35, No. 3, Pages 270-277.

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