Improving the utilisation and the awareness of high-sensitivity cardiac troponin test
Cardiac troponin is one of the biomarkers to diagnose a myocardial infarction and has been in use for many years. There has been many improvements in these biomarkers to aid in the diagnosis of a myocardial infarction. An improvement in troponin sensitivity to be specific. Each new generation of troponin has led to improved diagnostic sensitivity. The new generation of troponin are known as the high-sensitivity troponin. The advantage of the high-sensitivity troponin is the earlier detection of myocardial injury which can lead to a diagnosis of an infarction. However, with a higher sensitivity, comes a lower specificity. Non-cardiac aetiologies can also precipitate an elevation of troponin. Therefore, it is vital that the troponin test is used in an appropriate context or clinicians will face a risk of misinterpreting the results of elevated troponin which may lead to further invasive investigations. This Quality Improvement Plan (QIP) focuses on improving the utilisation and the awareness of the high-sensitivity troponin test. The intent of the QIP is to highlight the potential impact on patients should the troponin test not be utilised properly. Adopting specific QI tools including a driver diagram, the causes for improper utilisation of the troponin test are highlighted. The data collected include patient consults, cardiac MRI’s and coronary angiograms. A 2% increase is observed in coronary angiograms, an 18.5% and 4.1% increase in cardiology consults are observed in two consultant patient groups. No increase in cardiac MRI’s. Implementing a regular grand round presentation to medical practitioners, placing informative notices at nurse stations as well as implementing a biochemistry result reminding tool will be key to optimise medical practice, resulting in better patient centred care.