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Cost Containment: Use of Troponin testing in the Inpatient Wards Setting

Cost Containment: Use of Troponin testing in the Inpatient Wards Setting. Neal Kaushal, R2 DSR2, May 2013. Troponin Assay.

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Cost Containment: Use of Troponin testing in the Inpatient Wards Setting

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  1. Cost Containment: Use of Troponin testing in the Inpatient Wards Setting Neal Kaushal, R2 DSR2, May 2013

  2. Troponin Assay • Used to detect elevated levels of Troponin I and Troponin T in the blood, in order to differentiate between unstable angina and myocardial injury in patients with chest pain or acute coronary syndrome • A serum test, when ordered can be returned in a matter of less than a few hours

  3. Diagnosis of Myocardial Infarction • Detection of a rise and/or fall of cardiac biomarker values (preferably cTn with at least one value above the 99th percentile upper reference limit) and with at least one of the following: • Symptoms of ischemia • Development of pathologic Q waves in the ECG • New or presumed new significant ST-segment-T wave (ST-T) changes or new left bundle branch block (LBBB) • Identification of an intracoronary thrombus by angiography or autopsy • Imaging evidence of new loss of viable myocardium or a new regional wall motion abnormality.

  4. Other Conditions Which Can Cause Elevated Troponin • Critical illness, such as sepsis • Severe GI bleed (mismatch between O2 supply and myocardial demand) • Chemotherapy agents (e.g. anthracyclines) • Toxins and venoms • Carbon Monoxide or Cynanide poisoning

  5. Examining How Troponin is Ordered at UCI on Presentation • Study population: n=27 charts of patients admitted to the inpatient ward service by the Emergency Department • Inclusion criteria: Patients admitted to the ward services with anypresenting complaint • Exclusion criteria: Patients discharged from the ED after initial labs and workup were obtained

  6. Examining How Troponin is Ordered at UCI on Presentation of Chest Pain n=27 N=3 Chest pain, test (+) N=13 Chest pain, test (-) N=11 No Chest Pain

  7. The Non-Chest Pain Admissions • N=2: POSS NEW HEART FAILURE • N=1: CELLULITIS • N=2: ALTERED MENTAL STATUS • N=3: SOB POSS PNA • N=1: LOWER EXTREMITY SWELLING • N=2: ACUTE KIDNEY INJURY

  8. Cost of Troponin Testing • Cost of a single Troponin Assay: • $11.08 • In patients who were admitted with a chief complaint of chest pain, all of these patients underwent “serial” troponin assays, i.e. every 6-8 hours to rule out ACT • Multiply this by every patient admitted for chest pain, over the course of months or a year will be quite costly

  9. Take Home Points • Every test we run in the hospital costs money • Many are easy to run. But we should always keep in mind the indication and pre-test probability of the tests that we order • What may seem like an innocent test on one patient, when multiplied over many patients can add up to a costly sum!

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