The clinically effective use of cardiac markers by restructuring laboratory profiles at Cardiology wards

Area of Science:

• Clinical Laboratory Science
• Cardiology
• Healthcare Management

Background:

• Laboratory overutilization is a significant concern, linked to diagnostic errors and patient risk.
• Cardiac markers, specifically high-sensitive troponin T (hsTropT) and N-terminal pro brain natriuretic peptide (NTproBNP), are frequently overused in laboratory ordering profiles (LOPs).
• A collaborative demand management strategy was implemented with the Department of Cardiology to address this overutilization.

Purpose of the Study:

• To retrospectively evaluate the effectiveness of implemented demand management strategies in reducing cardiac marker testing.
• To assess the impact of these strategies on laboratory utilization and patient outcomes.
• To determine the optimal approach for managing cardiac marker test orders.

Main Methods:

• Implemented strategies included educational interventions and evidence-guided active test de-selection or permanent removal of hsTropT and NTproBNP from cardiology ward LOPs.
• Tests remained accessible upon request, ensuring availability for clinical need.
• Evaluated overutilization by measuring reductions in monthly test orders and assessed 30-day all-cause readmission rates and patient hospital stay duration.

Main Results:

• A mean reduction of 66.1% in hsTropT tests was observed.
• Educational measures alone reduced NTproBNP orders by 52.8%.
• Permanent removal of tests from LOPs further decreased NTproBNP orders to 75.8%; neither 30-day readmission rates nor hospital stay length increased.

Conclusions:

• Routine cardiac marker testing within LOPs demonstrates extensive overutilization.
• Educational interventions are effective in curbing cardiac marker overutilization.
• Combining educational measures with the removal of cardiac markers from LOPs offers a more potent strategy for managing test orders.