Quality Pit Crew

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Quality Pit Crew

• Troponin Fast Track

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Meet The Pit Crew

• Crew Chief- Stephen Kahn, PhD
• Co-Crew Chief- Mark Cichon, DO
• Gas Man-Cindy Blakemore
• Rt Front Tire Changer-Marianne Rider
• Rt Rear Tire Changer- JoAnn Molnar
• Lft Front Tire Changer- Alison Paglin
• Lft Rear Tire Changer- Diane Cotsilis
• Tire Catcher- Trisha Lamb
• Spotters- Core Lab Staff

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The Race Lab Support in the ED Evaluation of
Chest Pain Patients
To maximize quality of care and patient safety, a
high volume of high risk patients must be
assessed accurately with lab test TAT being
critical
Annual U.S. ED Patient Volumes
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Some Proteins Appear in the Bloodstream Faster
and Longer

• Cardiac troponins are the gold standard for lab
  assessment of patients with chest pain1 and
  appear in the bloodstream after an acute
  myocardial infarction or heart attack.

Blood levels of cardiac markers 2
Troponin CK-MB Myoglobin

• Jaffe et al Circulation 2000 102, 1216 - 1220
  Its time for a change to a troponin std
• Wu et al NACB SOLP Recommendations for the use
  of cardiac markers in coronary artery diseases.
  Clin Chem 45(7)1104-1121, 1999

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Start Your Engines

• GOAL Fast Track Results
• Troponin results on the patients chart in less
  than 60 minutes.
• Troponin tests are used to help diagnose a heart
  attack, to detect and evaluate mild to severe
  heart injury and to separate it from chest pain
  that may be due to other causes

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Pit Crew Challenge

• Reduce Troponin turn around time for cardiac
  patients
• Implement new Core instrumentation for Troponin
  testing
• Improve communication with the Emergency
  Department

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Caution Problems in the Pit

• Steep learning curve with new instrumentation,
  turn around time increases
• Pre-analytic/analytic problems with Troponin
  testing, turn around time increases
• Epic implementation, turn around time increases

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Lap 1 New Instrumentation

• New instrumentation for Troponins reduces testing
  time by 6 minutes
• Staff training on new instrumentation is enhanced
  with virtual and on site trainers to decrease the
  learning curve
• Turn around time is stable but not improving as
  anticipated
• .Back to the Pits

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Lap 2 Improved Specimen Handling

• All Troponin samples are triaged for correct ID,
  tube type and adequate sample volume
• All Troponin samples are manually processed by
  technologists and decanted into correct sampling
  container
• All Troponin samples are delivered to the testing
  technologist and announced as STAT
• Turn around time decreases by 10 minutes

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Lap 3 Electronic Result Verification

• Electronic result verification of Troponin
  results is implemented on the new instrumentation
• Electronic result verification allows for test
  results meeting defined criteria to be sent
  automatically from the instrument to EPIC without
  technologist intervention
• Turn around time for Troponins speeds to the
  lead position

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Crossing the Finish Line

• Meeting or exceeding the 60 minute turn around
  time supports optimal patient care and effective
  ED triage of chest pain patients which also
  contributes to LUHS performance on national
• hospital quality measures for
• treating AMI patients.

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Victory Circle

• Turn around time for Troponins is decreased by 18
  minutes from Lap 1 (19 minutes faster than the
  clinical threshold of 60 minutes)
• Troponin sample problems have been reduced with
  technologist triage
• Communication with the Emergency
  Department has improved for cardiac
  patients
• Patient LOS is decreased
  in the Emergency
  Department