| Title: |
Protocol for Improving Care by FAster risk-STratification through use of high sensitivity point-of-care troponin in patients presenting with possible acute coronary syndrome in the EmeRgency department (ICare-FASTER): A stepped-wedge cluster randomised quality improvement initiative |
| Authors: |
Pickering, John; Devlin, Gerard; Body, Richard; Sally, Aldous; Jaffe, Allan; Apple, Fred; Mills, Nicholas; Troughton, Richard; Kavsak, Peter; Peacock, Frank; Cullen, Louise; Lord, Sally; Muller, Christian; Joyce, Laura; Frampton, Christopher; Lacey, Cameron; Richards, Mark; Pitama, Suzanne; Than, Martin |
| Source: |
Medical Papers and Journal Articles |
| Publisher Information: |
ResearchOnline@ND |
| Publication Year: |
2024 |
| Collection: |
The University of Notre Dame, Australia: ResearchOnline@ND |
| Subject Terms: |
Medicine and Health Sciences |
| Description: |
Introduction: Clinical assessment in emergency departments (EDs) for possible acute myocardial infarction (AMI) requires at least one cardiac troponin (cTn) blood test. The turn-around time from blood draw to posting results in the clinical portal for central laboratory analysers is ~1–2 hours. New generation, highsensitivity, point-of-care cardiac troponin I (POC-cTnI) assays use whole blood on a bedside (or near bedside) analyser that provides a rapid (8 min) result. This may expedite clinical decision-making and reduce length of stay. Our purpose is to determine if utilisation of a POCcTnI testing reduces ED length of stay. We also aim to establish an optimised implementation process for the amended clinical pathway. Methods and analysis: This quality improvement initiative has a pragmatic multihospital stepped-wedge cross-sectional cluster randomised design. Consecutive patients presenting to the ED with symptoms suggestive of possible AMI and having a cTn test will be included. Clusters (comprising one or two hospitals each) will change from their usual-care pathway to an amended pathway using POC-cTnI—the ‘intervention’. The dates of change will be randomised. Changes occur at 1month intervals, with a minimum 2month ‘run-in’ period. The intervention pathway will use a POC-cTnI measurement as an alternate to the laboratory-based cTn measurement. Clinical decision-making steps and logic will otherwise remain unchanged. The POC-cTnI is the Siemens (Erlangen Germany) Atellica VTLi high-sensitivity cTnI assay. The primary outcome is ED length of stay. The safety outcome is cardiac death or AMI within 30 days for patients discharged directly from the ED |
| Document Type: |
article in journal/newspaper |
| Language: |
unknown |
| Relation: |
https://researchonline.nd.edu.au/med_article/1826 |
| Availability: |
https://researchonline.nd.edu.au/med_article/1826 |
| Accession Number: |
edsbas.970F8ABA |
| Database: |
BASE |