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Cited by 0Acute Myocardial Infarction ResearchClinical Laboratory Practices and Quality ControlEmergency and Acute Care Studies

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Safety, Efficiency, and Cost Conflicts in Emergency Department Point of Care Troponin Testing

Grabinski, Zoe, Swartz, Jordan L., Wang, Yelan, Itani, Aya, Aguero-Rosenfeld, Maria, Sanchez, Neldis, Gulati, Rajneesh, Wittman, Ian G., Smith, Silas W.·2026·Quality Management in Health Care
DOI 10.1097/qmh.0000000000000502
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Abstract

Background and Objectives: Assessment of acute coronary syndrome (ACS) has pressured rapid diagnostic evaluation through point of care troponins (POCT-Tns). However, POCT-Tns have demonstrated inconsistent accuracy compared to laboratory (LABT)-Tn. A POCT-Tn used inappropriately to “rule-out” ACS can lead to premature diagnostic closure. We aimed to minimize indiscriminate POCT-Tn testing, while balancing test turnaround time (TAT), institutional cost, and impact on patient time to disposition (TTD). Methods: A quality improvement (QI) initiative from 2018 to 2022 included educational interventions and electronic health record (EHR) adaptations. We evaluated test characteristics, trended test frequency, TATs, cost, and TTD. We used statistical process control charts to evaluate changes in test frequency over time. We used the Mann-Whitney U and Wilcoxon Signed-Rank Sum test to analyze changes in TAT, TTD, and cost. Results: POCT-Tn had high discordance with LAB-Tn (9.7%) and low sensitivity (52.5%). SPCs showed a significant decrease in POCT-Tn tests performed over time. LABT-Tn TATs were longer than POCT-Tn (54 vs 21 min; P < .001). Total Tn testing costs decreased by $668 827.83 annually. Compared to pre-initiative, arrival to disposition was 20 min longer for patients receiving a LABT-Tn ( P < .001) and 37 min shorter for patients receiving a POCT with reflex to LABT-Tn ( P < .001). Conclusion: POCT-Tn test characteristics may place patients at risk for missed ACS. A combined approach using education and EHR adaptations decreased use of indiscriminate POCT-Tn tests, decreased health care costs, and resulted in clinically appropriate changes in disposition times for this large cohort of ED patients.

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Research works printed but not linked: 34

  1. Benjamin, 2017, Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association., Circulation, 135, e146, 10.1161/CIR.0000000000000485 · DOI · Paper page
  2. Dawson, 2023, Healthcare cost burden of acute chest pain presentations., Emerg Med J, 40, 437, 10.1136/emermed-2022-212674 · DOI
  3. Aalam, 2020, National trends in chest pain visits in US emergency departments (2006-2016)., Emerg Med J, 37, 696, 10.1136/emermed-2020-210306 · DOI
  4. Bergmark, 2022, Acute coronary syndromes., Lancet, 399, 1347, 10.1016/S0140-6736(21)02391-6 · DOI
  5. Bhatt, 2022, Diagnosis and Treatment of Acute Coronary Syndromes: A Review., JAMA, 327, 662, 10.1001/jama.2022.0358 · DOI
  6. Riley, 2017, Cost analysis of the History, ECG, Age, Risk factors, and initial Troponin (HEART) Pathway randomized control trial., Am J Emerg Med, 35, 77, 10.1016/j.ajem.2016.10.005 · DOI
  7. Greenslade, 2018, Diagnostic accuracy of a new high-sensitivity troponin I assay and five accelerated diagnostic pathways for ruling out acute myocardial infarction and acute coronary syndrome., Ann Emerg Med, 71, 439, 10.1016/j.annemergmed.2017.10.030 · DOI
  8. Lee, 2023, Initial evaluation and management of patients presenting with acute chest pain in the emergency department., Curr Cardiol Rep, 25, 1677, 10.1007/s11886-023-01984-6 · DOI
  9. Kontos, 2022, ACC expert consensus decision pathway on the evaluation and disposition of acute chest pain in the emergency department: a report of the American College of Cardiology Solution Set Oversight Committee., J Am Coll Cardiol, 80, 1925, 10.1016/j.jacc.2022.08.750 · DOI
  10. Wereski, 2021, Cardiac troponin thresholds and kinetics to differentiate myocardial injury and myocardial infarction., Circulation, 144, 528, 10.1161/CIRCULATIONAHA.121.054302 · DOI
  11. Cullen, 2022, Point-of-care testing with high-sensitivity cardiac troponin assays: the challenges and opportunities., Emerg Med J, 39, 861, 10.1136/emermed-2021-211907 · DOI
  12. Lowry, 2023, Troponin in early presenters to rule out myocardial infarction., Eur Heart J, 44, 2846, 10.1093/eurheartj/ehad376 · DOI
  13. Gabayan, 2015, Emergency department crowding and outcomes after emergency department discharge., Ann Emerg Med, 66, 483, 10.1016/j.annemergmed.2015.04.009 · DOI
  14. Rahsepar, 2022, Point-of-care tests’ role in time metrics of urgent interventions in emergency department; a systematic review of literature., Arch Acad Emerg Med, 10, e82
  15. Amundson, 2015, Cardiac troponin assays: a review of quantitative point-of-care devices and their efficacy in the diagnosis of myocardial infarction., Clin Chem Lab Med, 53, 665, 10.1515/cclm-2014-0837 · DOI
  16. Lin, 2020, How to choose a point-of-care testing for troponin., J Clin Lab Anal, 34, e23263, 10.1002/jcla.23263 · DOI
  17. Apple, 2021, IFCC Committee on Clinical Application of Cardiac Bio-Markers. Implementation of high-sensitivity and point-of-care cardiac troponin assays into practice: some different thoughts., Clin Chem, 67, 70, 10.1093/clinchem/hvaa264 · DOI
  18. Bruinen, 2022, Point-of-care high-sensitivity troponin-I analysis in capillary blood for acute coronary syndrome diagnostics., Clin Chem Lab Med, 60, 1669, 10.1515/cclm-2022-0268 · DOI
  19. Boeddinghaus, 2020, Early Diagnosis of Myocardial Infarction With Point-of-Care High-Sensitivity Cardiac Troponin I., J Am Coll Cardiol, 75, 1111, 10.1016/j.jacc.2019.12.065 · DOI
  20. Sörensen, 2019, Diagnostic Evaluation of a High-Sensitivity Troponin I Point-of-Care Assay., Clin Chem, 65, 1592, 10.1373/clinchem.2019.307405 · DOI
  21. Zalama-Sánchez, 2024, Diagnostic performance of point-of-care high-sensitivity troponin in the exclusion of non-ST-elevation myocardial infarction in the emergency department., J Pers Med, 14, 762, 10.3390/jpm14070762 · DOI
  22. Garg, 2017, Cardiac biomarkers of acute coronary syndrome: from history to high-sensitivity cardiac troponin., Intern Emerg Med, 12, 147, 10.1007/s11739-017-1612-1 · DOI
  23. Altman, 1983, Measurement in medicine: the analysis of method comparison studies., Statistician, 32, 307, 10.2307/2987937 · DOI · Paper page
  24. Mohammed, 2008, Plotting basic control charts: tutorial notes for healthcare practitioners., Qual Saf Health Care, 17, 137, 10.1136/qshc.2004.012047 · DOI
  25. Amalberti, 2020, Managing risk in hazardous conditions: improvisation is not enough., BMJ Qual Saf, 29, 60, 10.1136/bmjqs-2019-009443 · DOI
  26. Pickering, 2018, Validity of a novel point-of-care troponin assay for single-test rule-out of acute myocardial infarction., JAMA Cardiol, 3, 1108, 10.1001/jamacardio.2018.3368 · DOI
  27. Bingisser, 2012, Cardiac troponin: a critical review of the case for point-of-care testing in the ED., Am J Emerg Med, 30, 1639, 10.1016/j.ajem.2012.03.004 · DOI
  28. Apple, 2004, Analytical performance of the i-STAT cardiac troponin I assay., Clin Chim Acta, 345, 123, 10.1016/j.cccn.2004.03.010 · DOI
  29. Tsui, 2019, Analytical concordance of diverse point-of-care and central laboratory troponin I assays., J Appl Lab Med, 3, 764, 10.1373/jalm.2018.026690 · DOI
  30. Grunau, 2018, Commentary: sensitivity, specificity, and predictive values: foundations, liabilities, and pitfalls in research and practice., Front Public Health, 6, 256, 10.3389/fpubh.2018.00256 · DOI
  31. Leeflang, 2013, Variation of a test’s sensitivity and specificity with disease prevalence., CMAJ, 185, E537, 10.1503/cmaj.121286 · DOI · Paper page
  32. Xu, 2019, Prevalence and predictability of low-yield inpatient laboratory diagnostic tests., JAMA Netw Open, 2, e1910967, 10.1001/jamanetworkopen.2019.10967 · DOI · Paper page
  33. Bentley, 2012, Implications of the impact of prevalence on test thresholds and outcomes: lessons from tuberculosis., BMC Res Notes, 5, 563, 10.1186/1756-0500-5-563 · DOI
  34. Macrae, 2016, The problem with incident reporting., BMJ Qual Saf, 25, 71, 10.1136/bmjqs-2015-004732 · DOI

Metadata

Authors
Grabinski, Z., Swartz, J. L., Wang, Y., Itani, A., Aguero-Rosenfeld, M., Sanchez, N., Gulati, R., Wittman, I. G., & Smith, S. W.
Affiliations
  • NYU Langone Health (US)
  • Author Affiliations:Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine (Drs Grabinski, and Swartz, Ms Wang, and Drs Itani, Gulati, Wittman, and Smith), Department of Pathology (Dr Aguero-Rosenfeld), Clinical Laboratories (Dr Aguero-Rosenfeld and Ms Sanchez), Institute for Innovations in Medical Education, New York University Grossman School of Medicine (Dr Smith), NYU Langone Health, New York.
Corresponding author
Grabinski, Zoe
ORCID
Venue
Quality Management in Health Care
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2025-05-08
Volume
35
Issue
3
Pages
175-182
ISSN
  • 1063-8628 (ISSN-L)
  • 1550-5154
DOI
10.1097/qmh.0000000000000502
OpenAlex
W4410360118
Cited by
0
References
3
FWCI
0.00
Type
journal article
Language
en
Open access
closed
Locations
  • Quality Management in Health Care (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
  • Health Sciences › Health Professions › Medical Laboratory Technology › Clinical Laboratory Practices and Quality Control
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Keywords
acute coronary syndrome, emergency department, test turnaround time, time to disposition, diagnostic accuracy, cost reduction, electronic health record interventions, provider education, quality improvement
MeSH terms
Point-of-Care Testing, Emergency Service, Hospital, Humans, Time Factors, Troponin, Efficiency, Organizational, Acute Coronary Syndrome, Electronic Health Records, Quality Improvement, Patient Safety

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