Clinical & Experimental Cardiology
Open Access

Abstract

Troponin Testing in the Emergency Setting: How Good are we?

Gemina Doolub, Gina Hadley and Jeremy Dwight

Objectives: The purpose of this audit was to ascertain whether troponin tests are requested appropriately for acute admissions via A&E and EAU at the John Radcliffe Hospital, Oxford. Troponin tests are not 100% specific, and commencing the ACS protocol is not without risks. Inappropriate tests could result in minimally positive levels, and starting antiplatelets in these situations could lead to unnecessary complications. Methods: Data was collected on two 24-hour periods for all admissions to A&E and EAU (Emergency Assessment Unit). Admissions were monitored on the electronic whiteboard and follow-up was through a combination of reading notes and using ‘Case Notes’. The primary outcome was whether troponin tests were requested appropriately. Criteria for appropriateness of requests were decided after meeting with cardiologists. The secondary outcome was whether the troponin tests were requested within an appropriate time frame, i.e. at admission and at 12 hours. Results: A total of 55 patients had troponin tests. Mean age was 72.3 years. Nine requests came via EAU and the majority through A&E. Of these 55 patients, 40% had a troponin requested inappropriately, the majority of which were requested by the nursing staff. Mean time for the first troponin test was 63.5 minutes. Repeat troponins were requested at a range (5 hours to 13 hours). Three patients were actually started on ACS protocol inappropriately. The cost of inappropriate tests totaled £320. Conclusion: Although there were no adverse events in the patients that were sampled during this audit, the ACS protocol was started inappropriately in three patients. Cutting down inappropriate troponin tests in the acute setting could, by extrapolation, amount to savings of £58,400 per annum. We presented this audit at several local and regional meetings, and came up with recommendations to put in place within our hospital. Our intervention in the form of checklists, posters and widespread teaching, improved results considerably, with only 5% inappropriate tests requested in the second audit cycle.