Emergency Department Clinician Perceptions of Implementing High-Sensitivity Troponin T Assay in an Academic Hospital Emergency Department

Rylee S Doucette; Emily Dibble; Nonie S Arora; David M Somand; Steven Kronick; Eve Kerr; Scott Flanders; Geoffrey D Barnes

doi:10.1016/j.amjmed.2020.01.039

Emergency Department Clinician Perceptions of Implementing High-Sensitivity Troponin T Assay in an Academic Hospital Emergency Department

Am J Med. 2020 Sep;133(9):e483-e494. doi: 10.1016/j.amjmed.2020.01.039. Epub 2020 Mar 9.

Authors

Rylee S Doucette¹, Emily Dibble², Nonie S Arora³, David M Somand⁴, Steven Kronick⁵, Eve Kerr⁶, Scott Flanders⁷, Geoffrey D Barnes⁸

Affiliations

¹ School of Public Health, University of Michigan, Ann Arbor; Michigan Program on Value Enhancement, Michigan Medicine, Ann Arbor, Mich.
² Department of Learning Health Sciences, University of Michigan, Ann Arbor.
³ University of Michigan Medical School, Ann Arbor.
⁴ Department of Emergency Medicine, University of Michigan, Ann Arbor; Institute for Healthcare Policty and Innovation, University of Michigan, Ann Arbor, Mich.
⁵ Department of Emergency Medicine, University of Michigan, Ann Arbor.
⁶ VA Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, Mich; Department of Internal Medicine, Institute of Healthcare Policy and Innovation, Ann Arbor, Mich; Institute for Healthcare Policty and Innovation, University of Michigan, Ann Arbor, Mich.
⁷ Department of Internal Medicine, Institute of Healthcare Policy and Innovation, Ann Arbor, Mich; Institute for Healthcare Policty and Innovation, University of Michigan, Ann Arbor, Mich.
⁸ Frankel Cardiovascular Center, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich; Institute for Healthcare Policty and Innovation, University of Michigan, Ann Arbor, Mich. Electronic address: gbarnes@umich.edu.

PMID: 32165187
DOI: 10.1016/j.amjmed.2020.01.039

Abstract

Purpose: A newly approved, high-sensitivity troponin T (hsTnT) assay may offer opportunities to more rapidly assess for acute coronary syndrome and identify lower thresholds of myocardial injury. As more emergency departments begin to use the hsTnT assay, anticipating barriers to hsTnT implementation success are critical to realizing potential benefits in rapid, accurate patient assessment.

Methods: At a tertiary health system emergency department, hsTnT was implemented along with a diagnostic algorithm and a decision tree to aid in utilization. Qualitative interviews with 18 physicians and advance practice providers were conducted 2 months' postimplementation and again 4 to 6 months postimplementation to capture clinician perceptions to hsTnT implementation efforts. Deductive coding was performed using implementation science determinants frameworks to identify emerging themes related to this topic.

Results: Four themes emerged from the interviews: 1) the need for additional clinician education, 2) challenges with care handoffs, 3) lack of buy-in from the hospital community, and 4) key successes.

Conclusion: Interviews demonstrated that implementation of hsTnT was associated with several implementation barriers from the perspective of emergency department clinicians. Future implementation efforts should focus on diverse and sustained staff educational efforts, models that address challenges with care handoffs between emergency department clinicians and inpatient clinicians, and operational teams that include inpatient clinicians to facilitate buy-in.

Keywords: Chest pain; Diagnostic algorithm; ERIC strategies; Emergency medicine; HEART score; High-sensitivity troponin T (hsTnT); Qualitative.

MeSH terms

Acute Coronary Syndrome / blood
Acute Coronary Syndrome / diagnosis*
Biomarkers / blood
Emergency Service, Hospital*
Health Knowledge, Attitudes, Practice
Hospitals, Teaching*
Humans
Physicians*
Sensitivity and Specificity
Troponin T / blood*

Substances

Biomarkers
Troponin T