1. Quality Pit Crew Troponin Fast Track

2. 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

3. 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 The Race: Lab Support in the ED Evaluation of Chest Pain Patients* * Annual U.S. ED Patient Volumes

4.  Cardiac troponins are the gold standard for lab assessment of patients with chest pain 1 and appear in the bloodstream after an acute myocardial infarction or heart attack. 1Jaffe et al: Circulation 2000; 102, 1216 - 1220 “It’s time for a change to a troponin std” 2Wu et al NACB SOLP: Recommendations for the use of cardiac markers in coronary artery diseases. Clin Chem 45(7):1104-1121, 1999 Some Proteins Appear in the Bloodstream Faster and Longer Troponin CK-MB Myoglobin Blood levels of cardiac markers 2

5. Start Your Engines  GOAL: Fast Track Results  Troponin results on the patient’s 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

6. Pit Crew Challenge  Reduce Troponin turn around time for cardiac patients  Implement new Core instrumentation for Troponin testing  Improve communication with the Emergency Department

7.  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

8. 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

9. 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

10. 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

12. 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.

13. 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