Case Study: Supporting the implementation of the early rule out hsTn pathway in a busy emergency department

What is the hsTn pathway?

High sensitivity troponin (hsTn) assays are recommended as a diagnostic option to rule out minor heart attacks in patients who present to an emergency department with chest pain, usually suggestive of an acute coronary syndrome (ACS).

The hsTn pathway allows for baseline assessment of troponin which can be repeated at one or three hours post presentation, as opposed to six hours with traditional assays. This allows for the early rule out of ACS, assisting clinical decision-making and improving patient care.

What were the aims of the hsTn pathway?

To support transformation of the clinical pathway used to triage and diagnose patients presenting with chest pain

To increase efficiencies in resource utilisation and improve patient care and clinical outcomes

What did we do?

We supported the implementation of the hsTn pathway in a busy emergency department, by facilitating engagement and collaboration between multiple disciplines and departments.

We worked with all parties to ensure the pathway for implementation of the test, early discharge and onward referral was managed with minimal disruption. A revised clinical pathway was also adopted, and chemical pathology reporting systems were updated to allow for the early rule out test to be undertaken.

What were the outcomes?

The pathway’s implementation has resulted in reduced turnaround times for test results. Patient management has also improved, through either earlier discharge or prompt onward referral to a ward area for clinical management.