The FDA has approved the use of high-sensitive troponin T (hsTnT) assays to aid in the diagnosis of myocardial infarction, many organizations are trying to determine the best approach to take for the blood test's roll out in their facilities. There are considerations to be planful of, of course, from those around developing a chest pain algorithm to the clinical training necessary to support the go-live. But your most important move no matter the potential challenge? Ensuring you have a strong—and multidisciplinary—hsTnT implementation team.
Here's a quick look at who should be included on that team, and some advice for picking the stakeholders best suited to spearhead your implementation effort.
Your first step should be to identify a clinical champion for the implementation—the one individual at your organization who can lead the project from start to finish. For many health systems, this will be the medical director from the emergency department (ED), since that's where hsTnT will be ordered most often and the benefit most felt.
From there, says Elsie Yu, PhD, DABCC, FACB, medical laboratory director at Geisinger Health System and clinical associate professor at Geisinger Commonwealth School of Medicine, it's time to focus on your core implementation team. At her institution, Dr. Yu says, their medical director was appointed to guide the overall effort, and then leaders from the ED or cardiology departments at each of the system's 10 hospitals were brought on to direct implementation within their own facilities. “It's challenging, I think, when you have a big hospital system and you need to include every site," Dr. Yu notes, because you'll likely have more people who want to participate than you have room for on the team. “You only have so many seats available."
Among the other individuals you should consider including on your hsTnT core roster: your director of nursing, your critical care nursing educator, your laboratory's medical director and administrative director, a clinical informaticist, and your chest pain/stroke coordinator. “You want to make sure that everybody who is going to be touched by this is aware and involved," says Ibrahim Hashim, MSc, PhD, DABCC, FIBMS, CSc, FACB, medical director for clinical chemistry at Parkland Hospital and Health System and point-of-care testing director at UT Southwestern Medical Center.
Once your leadership and core team are in place, your next step should be to bring other stakeholders up to speed. Exactly who that includes will depend on your organization, but hospitalists, critical care clinicians, quality control and risk- management specialists, and electronic medical records administrators should all be involved, as should C-suite executives like your chief operations officer and chief medical officer. At his organization, Dr. Hashim says, “we realized this was going to be a very important project—that it would impact a lot of areas in our hospitals." They discussed their plans with hospital leadership, and made it clear the implementation would require “a lot of resources," including education and training of nurses, residents, and faculty. “Anybody that will be ordering that assay."
In the end, Dr. Hashim explains, his organization's hsTnT implementation proceeded without a hitch in large part because they had buy-in and support across the system. They also leaned heavily on a project manager who “did a fantastic job pulling everybody together" and ensuring that tasks were completed according to their implementation timeline. And, he says, everybody involved was “well-aware and well- informed" of what the process required every step of the way. “That really was the key to success."
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Use of high-sensitivity troponin T is associated with fewer adverse events in patients with chest pain
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This study investigates whether the implementation of hsTnT assays in Swedish hospitals resulted in reduced incidence of MACE in this patient group. MACE was defined as a hospital stay with myocardial infarction (MI), unplanned revascularization, or all-cause mortality.