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

IF 1.2 4区医学 Q4 HEALTH CARE SCIENCES & SERVICES

Quality Management in Health Care Pub Date : 2025-05-08 DOI:10.1097/QMH.0000000000000502

Zoe Grabinski, Jordan L Swartz, Yelan Wang, Aya Itani, Maria Aguero-Rosenfeld, Neldis Sanchez, Rajneesh Gulati, Ian G Wittman, Silas W Smith

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引用次数: 0

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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急诊科护理点肌钙蛋白检测的安全性、效率和成本冲突。

背景和目的：急性冠状动脉综合征（ACS）的评估迫使通过护理点肌钙蛋白（POCT-Tns）进行快速诊断评估。然而，与实验室(LABT)-Tn相比，poct -Tn显示出不一致的准确性。不恰当地使用POCT-Tn来“排除”ACS可能导致过早的诊断关闭。我们的目标是尽量减少不加区分的POCT-Tn检测，同时平衡检测周转时间（TAT）、机构成本和对患者处置时间（TTD）的影响。方法：2018年至2022年的质量改善（QI）倡议包括教育干预和电子健康记录（EHR）的适应。我们评估了测试特性、趋势测试频率、TATs、成本和TTD。我们使用统计过程控制图来评估测试频率随时间的变化。我们使用Mann-Whitney U和Wilcoxon Signed-Rank Sum检验来分析TAT、TTD和成本的变化。结果：POCT-Tn与LAB-Tn不一致性高（9.7%），敏感性低（52.5%）。随着时间的推移，SPCs的POCT-Tn测试显著下降。LABT-Tn TATs比POCT-Tn更长(54 min vs 21 min；结论：POCT-Tn试验特征可能使患者有漏诊ACS的风险。采用教育和电子病历调整相结合的方法减少了不加区分的POCT-Tn测试的使用，降低了医疗保健成本，并导致这一大批急诊科患者处置时间的临床适当变化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Quality Management in Health Care HEALTH CARE SCIENCES & SERVICES-

CiteScore

1.90

自引率

8.30%

发文量

108

期刊介绍： Quality Management in Health Care (QMHC) is a peer-reviewed journal that provides a forum for our readers to explore the theoretical, technical, and strategic elements of health care quality management. The journal''s primary focus is on organizational structure and processes as these affect the quality of care and patient outcomes. In particular, it: -Builds knowledge about the application of statistical tools, control charts, benchmarking, and other devices used in the ongoing monitoring and evaluation of care and of patient outcomes; -Encourages research in and evaluation of the results of various organizational strategies designed to bring about quantifiable improvements in patient outcomes; -Fosters the application of quality management science to patient care processes and clinical decision-making; -Fosters cooperation and communication among health care providers, payers and regulators in their efforts to improve the quality of patient outcomes; -Explores links among the various clinical, technical, administrative, and managerial disciplines involved in patient care, as well as the role and responsibilities of organizational governance in ongoing quality management.