Reducing redundant creatine kinase testing in cardiac injury

Area of Science:

• Cardiology
• Clinical Pathology
• Healthcare Quality Improvement

Background:

• Creatine kinase (CK) testing is frequently used for suspected cardiac injury but offers limited value beyond troponin testing.
• Unnecessary CK testing contributes to healthcare costs without improving patient outcomes.

Purpose of the Study:

• To evaluate and implement strategies to reduce creatine kinase (CK) testing by 50% or more in patients with suspected cardiac injury.
• To assess the impact of reduced CK testing on overall diagnostic costs and clinical practice.

Main Methods:

• A root cause analysis identified patterns in CK testing processes.
• New institutional guidelines were developed, CK was removed from order bundles, and academic detailing was conducted.
• Patient data from Sunnybrook Health Sciences Centre (Jan 2018 - Mar 2020) were analyzed for CK and troponin testing rates.

Main Results:

• Total CK tests decreased by 46.7% (from 3963 to 2111 per month), exceeding the 50% target reduction.
• The ratio of CK-to-troponin tests significantly decreased from 0.91 to 0.49.
• Reductions were sustained post-intervention, observed across all units, and resulted in projected annual savings of C$28,446.

Conclusions:

• A low-cost quality improvement initiative effectively reduced unnecessary CK testing for suspected cardiac injury.
• Significant healthcare cost savings were achieved through optimized diagnostic testing strategies.
• The findings support the broader implementation of similar initiatives to improve healthcare efficiency.