Abstract 17099: Implementation of a High Sensitivity Troponin-I Assay in an Academic Medical Center: A Qualitative and Quantitative Assessment

Abstract

Background: High sensitivity troponin assays (hsTn) have received regulatory approval for use in the United States and health care facilities are beginning to adopt these new assays. Questions remain about how to implement these assays and what affect they may have on demand for cardiovascular services. Methods and Results: We conducted a mixed-methods implementation science-based investigation of hsTn adoption at a single academic medical center. We designed the investigation based on the Consolidated Framework for Implementation Research, exploring clinicians’ perspectives on intervention characteristics, inner setting, individual characteristics, and process of implementation domains. Focus groups were conducted with clinicians from multiple service lines. Participants reported that the new hsTn assay did not fundamentally change processes of care such as cardiology consultations or inpatient admissions. Implementation was facilitated by leveraging the electronic medical record to provide useful suggestions for hsTn management at the point-of-care. Participants expressed satisfaction with the multidisciplinary and collaborative approach taken to educating clinicians prior to implementation. The use of case-based teaching was considered most effective. Emergency department clinicians expressed greater confidence about decisions to discharge to home with the hsTn assay, compared to the older assay. Areas of ongoing concern included management of high risk patients, outpatient follow-up, and feasibility of accelerated diagnostic protocols for early discharge from the emergency department. Deidentified quantitative data on cardiovascular service use were gathered from administrative sources and analyzed on runcharts. A decrease in the number of hsTn assays ordered was observed; no change was noted for admissions, cardiology consultations, or noninvasive cardiac imaging. Conclusions: A comprehensive educational campaign, based on multidisciplinary collaboration can effectively prepare clinicians for implementation of hsTn. New hsTn assays may not have any substantial effect of acute management of patients with cardiac complaints. Many questions remain about best clinical practices for hsTn assays.