438 Accelerating the Care of Patients Presenting to Queensland Health EDs with Suspected ACS. Timely Translation of Advances in Care. – The Statewide ACRE II Project

Abstract

In October 2018 Pathology Queensland introduced a new high-sensitivity cardiac Troponin assay (hsTnI) to all Queensland Health (QH) Hospitals. The Accelerated Chest pain Risk Evaluation (ACRE) Project conducted a multi-modal education campaign to facilitate implementation of new suspected ACS clinical pathways to hospitals across Queensland. Troponin is the key biomarker for the identification of patients with an acute myocardial infarction. The new assay has greater analytical precision than its predecessor; however, without dedicated support for the change in clinical protocols, laboratory transition to the new assay may have questionable impact on hospital efficiency. There was the possibility of confusion due to key differences in interpretation of the new assay, which include: results reported in different units; new reference ranges, including the introduction of sex specific ranges; and reported Z-scores. The campaign reached stakeholders from the 33 QH hospitals who use a laboratory-based troponin assay. The campaign message was disseminated via videoconference education sessions, an educational video, email, screensavers, and QH intranet. Data comparing the 6 months before contact with the ACRE Project and 6 months after introduction of the new assay demonstrate state-wide improvements in both admission rates and hospital length of stay (LOS). Following the assay change, admissions for suspected ACS patients across all 33 hospitals reduced by 6.8% (37.6% pre-ACRE and 30.8% post-hs-cTnI) equating to 5,169 fewer inpatient admissions each year. A state-wide reduction in median hospital LOS of 1.8 hours (8.8 to 7.0 hours; 20% reduction) for suspected ACS presentations equates to 5,674 released bed days annually.