Improved efficiency and cost reduction in the emergency department by replacing contemporary sensitive with high-sensitivity cardiac troponin immunoassay

Improved efficiency and cost reduction in the emergency department by replacing contemporary sensitive with high-sensitivity cardiac troponin immunoassay

Authors

  • Rosalia Aloe University Hospital of Parma
  • Giuseppe Lippi University of Verona
  • Martina Di Pietro University Hospital of Parma
  • Laura Bonfanti University Hospital of Parma
  • Mariella Dipalo University Hospital of Parma
  • Ivan Comelli University Hospital of Parma
  • Paola Avanzini University Hospital of Parma
  • Fabian Sanchis-Gomar University of Valencia
  • Gianfranco Cervellin University Hospital of Parma, Italy

Keywords:

cardiac troponin; high-sensitivity, myocardial infarction, acute coronary syndrome, emergency department

Abstract

Background: Although unquestionable evidence has been provided that high-sensitive (HS) cardiac troponin (cTn) immunoassay outperform the former contemporary-sensitive techniques, some clinicians are still hesitant to implement HS methods in routine clinical practice. This study was hence planned to evaluate the impact of replacing a contemporary-sensitive with HS cTnI immunoassay on hospital and laboratory workload. Methods: Information on the total number of cTnI tests ordered, total number of blood samples collected, total number of CK-MB tests ordered, number of patients with the first HS-cTnI value below the limit of detection (LoD) and cumulative HS-cTnI values was extracted from the local hospital information system for the semesters before and after the HS method was introduced. Results: Although the total emergency department (ED) visits modestly increased after introducing HS-cTnI, the number of total cTnI tests declined by over 10%. A substantial reduction of single-sample test requests was noted, accompanied by a considerable decline of 3- and 4-sample collections (i.e., -61% and -73%, respectively). A high percentage of patients (27.5%) displayed HS-cTnI values <LoD at admission, thus allowing safe discharge. The introduction of HS cTnI immunoassay was effective to collapse the number of CK-MB test requested and also generated favorable return of investment for the part of laboratory budget concerning cTnI testing (-3.2% of total costs for cTnI and -99.8% of total costs for CK-MB). Conclusion: The results of this study show substantial organizational and economic benefits by replacing contemporary-sensitive with HS cTnI immunoassays. (www.actabiomedica.it)

Author Biographies

Rosalia Aloe, University Hospital of Parma

Laboratory Medicine

Giuseppe Lippi, University of Verona

Clinical Chemistry

Martina Di Pietro, University Hospital of Parma

Laboratory Medicine

Laura Bonfanti, University Hospital of Parma

Emergency Department

Mariella Dipalo, University Hospital of Parma

Laboratory Medicine

Ivan Comelli, University Hospital of Parma

Emergency Department

Paola Avanzini, University Hospital of Parma

Laboratory Medicine

Fabian Sanchis-Gomar, University of Valencia

Cardiology

Gianfranco Cervellin, University Hospital of Parma, Italy

Emergency Department

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Published

23-12-2019

Issue

Section

EMERGENCY MEDICINE UP DATE (Editor: Gianfranco Cervellin)

How to Cite

1.
Aloe R, Lippi G, Di Pietro M, Bonfanti L, Dipalo M, Comelli I, et al. Improved efficiency and cost reduction in the emergency department by replacing contemporary sensitive with high-sensitivity cardiac troponin immunoassay. Acta Biomed [Internet]. 2019 Dec. 23 [cited 2024 Jul. 19];90(4):614-20. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/8769