Evaluating the impact of rapid high sensitivity troponin testing within a community hospital emergency department: A pilot study

Abstract

Background: Chest pain is a common presenting complaint to emergency departments (EDs), and many low-risk patients require serial troponin levels to rule out Acute Coronary Syndrome (ACS) prior to discharge. Troponin levels can take ≥ 1 hour to result, contributing to an increased length of stay (LOS). Point-of-care or rapid testing can expedite these testing and result times. The aim of this study was to evaluate the workflow and feasibility of the QuidelTriage® MeterPro (a rapid testing meter) for high sensitivity troponin testing for low-risk cardiac patients presenting with chest pain to the Oak Valley Health (OVH) -  Markham Stouffville Hospital (MSH) ED.

Methods: The Plan-Do-Study-Act (PDSA) cycle was used to guide the implementation and evaluation of the QuidelTriage® MeterPro, using TriageTrue® High Sensitivity Troponin I testing within the ED. This pilot study evaluated the change in theoretical patient ED LOS and cost effectiveness of the device when compared to standard of care (SOC) procedures and workflows. Screening and recruitment was completed on weekdays within the ambulatory zones of the ED for low-risk patients presenting with chest pain requiring serial troponin testing. Patients consented to have extra blood drawn with their SOC bloodwork to run the analysis on the meter. Rapid testing results were blinded until data analysis.

Results: N = 19 patients participated in the pilot study from February 2024 to September 2024. Interim data analysis showed the average LOS for low-risk cardiac patients was 5 hours and 8 minutes. Results demonstrated that the meter reported faster troponin results than central lab processing (M = 16 min and M = 1 hour and 2 min, respectively). Similarly, repeat troponin results demonstrated faster time to results using the meter compared to central lab (M = 18 min and M = 53 min, respectively). In summary, using the meter could have reduced theoretical ED LOS to 3 hours and 47 min and lab waiting time by 70.43%. All results from the QuidelTriage® MeterPro matched the results from the central lab Beckman Coulter-DXI600 analyzer. The cost analysis is being completed by the study team.

Implications and lessons learned: Implementation of a rapid troponin testing meter such as the QuidelTriage® MeterPro within the mobile lab at OVH - MSH ED reduces troponin result time. This can improve workflows within the ED to reduce physician reassessment time and ultimately reduce the patients’ LOS. In some patient scenarios, rapid testing could replace central lab testing. Rapid troponin testing devices have the potential to optimize care within community and rural settings by improving throughput efficiency and by enabling the rapid identification of acute cardiac events. Next steps include further evaluation of the feasibility of rapid troponin testing for high-risk cardiac patients, in addition to further cost analyses for implementation planning.