Implementation of high sensitivity troponin in a veterans health system: Lessons learned

Abstract

Aim: To describe the implementation of a high sensitivity (hsTn) assay at a large academically affiliated Veteran Affairs medical center. Methods: Approximately 6 months time was utilised for adoption of a new hsTn assay in clinical practice at our facility. We assembled a multidisciplinary team of front-line clinicians to determine which actions would best prepare the facility for the transition. Identified goals included: maximizing sensitivity of the assay, minimizing confusion for clinicians, making adoption as easy as possible for the end users, and encouraging clinicians to use uniform terminology while referring to troponin results. One month prior to the new assay initiation, educational interventions included live learning sessions, pre-recorded lectures, slide decks, and printed materials. Communication to the entire clinical staff was accomplished through staff meetings and email announcements. An abbreviated “top things to remember about hsTn list” was widely shared. Results: After adoption, the cardiology service received minimal consultation requests from clinicians unaware of the change or uncomfortable with how to interpret the hsTn results. In quantitative assessment, we observed no change in the rate of cardiology consultations, electrocardiograms or cardiac stress tests. Conclusion: A multidisciplinary implementation focused on application by the bedside and ample education were effective in creating a seamless transition to hsTn.