Verification and Implementation of a Point-of-Care Troponin Test in an Emergency Department: Successes and Challenges

Optimizing care for patients suspected of having acute coronary syndromes relies on timeliness of key information that impacts intervention decisions. Improvement in turnaround times for troponin in emergency departments (EDs) is a key success measure for providing quality care for this patient population. Here we describe the verification and implementation of point-of-care testing (POCT) for troponin in an urban community academic ED with a volume of 62,000 patients per year. Initially, we compared different commercially available tests with the laboratory instruments and found a vendor that performed best with concordance rates above 80%. After instrument selection, we evaluated workflow for one week using a borrowed instrument. We determined that respiratory therapists in the ED would be primarily responsible for testing, with charge nurse backup, and that two instruments were necessary to manage the workload due to the surge of patients requiring this testing. Once instruments were purchased, the point-of-care team performed verification (comparison, precision and linearity). After go-live, we are performing an average of 14 tests per day (range two-28). The mean time of patient arrival to results from the POCT is 1:03 hours, compared to 1:51 hours from the laboratory. During the first 6 weeks, some cases were run by both the laboratory and POCT, and the discrepancy rate was 11%. Early challenges encountered and solved were timely interface of POCT results with the electronic medical record, availability of supplies, process for critical result notification, and reporting results during downtimes. Opportunities for improvement include standardization of ED provider test ordering practice and expansion of troponin testing from initial only to serial testing.