Abstract
Background Chest pain was the fourth most common reason for Adult Emergency Department (AED) visits at Al Wakra Hospital (AWH) from January to September 2022. Among the 11,125 patients who underwent the Troponin T test during this period, the median time from physician order to sample collection was 45 minutes. Improving the efficiency of cardiac biomarker processes is crucial for the early diagnosis and management of myocardial infarction patients in the AED.1,2 Therefore, our aim is to decrease the median time from physician order to sample received in the laboratory at AWH-AED from 45 minutes to 30 minutes by October 2023.
Methods The project team rigorously followed the IHI model for improvement. In order to pinpoint the primary factors causing delays in the collection and transfer of Troponin T samples from the emergency room to the laboratory, a comprehensive process map was developed. Employing fishbone analysis, the team identified the root causes and explanatory variables contributing to the delays (figure 1). This thorough analysis provided valuable insights essential for refining and streamlining the process.
Results The findings indicated a significant improvement, with the median physician order to blood sample in-laboratory time decreasing to 30 minutes (figure 2). This improvement allows the laboratory department sufficient time to process the sample and provide results within the targeted timeframe. The implementation of interventions resulted in a more efficient Troponin T process, contributing to improved patient care and timely diagnostic result delivery.
Conclusion The continuity of our achievements relies on the steadfast maintenance of implemented changes. To guarantee this sustainability, we are committed to preserving the practices already set in motion. This proactive approach ensures ongoing success and allows for timely adjustments as needed, fostering a culture of continuous improvement within our department.
Root causes and explanatory variables contributing to the delays in the collection and transfer of troponin T samples from the emergency room to the laboratory for chest pain patients seen in the adult emergency department of Al Wakra hospital, Qatar
Outcome measure: median troponin T physician order to sample received in laboratory
References
Ison T, Morris L, Wilkerson G, Schmidt C, Winchester DE. Process improvements to reduce cardiac troponin turnaround time in the emergency department. Critical Pathways in Cardiology 2016 Sep;15(3):95–7.
Boelstler AM, Rowland R, Theoret J, Takla RB, Szpunar S, Patel SP, et al. Decreasing troponin turnaround time in the emergency department using the central laboratory: a process improvement study. Clinical Biochemistry 2015 Mar;48(4–5):308–12. https://doi.org/10.1016/j.clinbiochem.2014.10.014
Ethical Approval/IRB Statement Approval for the publication of this Quality Improvement (QI) project was obtained from our institution prior to submission.
Disclosures and Acknowledgments I have no disclosures or acknowledgments.
