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
Publication Details
Pickering, J.,
Devlin, G.,
Body, R.,
Sally, A.,
Jaffe, A.,
Apple, F.,
Mills, N.,
Troughton, R.,
Kavsak, P.,
Peacock, F.,
Cullen, L.,
Lord, S.,
Muller, C.,
Joyce, L.,
Frampton, C.,
Lacey, C.,
Richards, M.,
Pitama, S.,
&
Than, M.
(2024).
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.
BMJ Open, 14 (6).
Abstract
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
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