Rachel D Le1, Joshua M Kosowsky2, Adam B Landman2, Ida Bixho1, Stacy E F Melanson3, Milenko J Tanasijevic4. 1. Department of Pathology, Brigham and Women's Hospital, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA. 2. Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA. 3. Department of Pathology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA. 4. Department of Pathology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: mtanasijevic@partners.org.
Abstract
CONTEXT: Cardiac troponins T and I have replaced creatine kinase-MB (CK-MB) as the criterion standard for diagnosing myocardial injury. However, many laboratories still routinely perform a high volume of CK-MB testing in conjunction with troponin. PURPOSE: The purpose of this study is to study the clinical and financial impact of removing CK-MB from the routine emergency department (ED) test menu at a large academic medical center. METHODS: Creatine kinase-MB was removed from ED ordering templates and laboratory requisitions (ie, intervention), although the test could still be manually ordered. Data for creatine kinase (CK), CK-MB, and troponin T (TnT) specimens ordered during a 12-month period (6 months preintervention and 6 months postintervention) (n = 14571) was downloaded from our laboratory information system. All specimens with (1) normal TnT (ie, <0.01 ng/mL), (2) elevated CK-MB (ie, >6.6 ng/mL), and (3) elevated CK-MB index (ie, >5) were considered discrepant and independently reviewed by 2 ED clinicians for the presence of an acute coronary syndrome and for documentation of final diagnosis. Creatine kinase, CK-MB, and TnT ED volumes preintervention and postintervention were analyzed to assess laboratory cost savings. RESULTS: Of the 6444 cases included in the analysis, only 17 were discrepant. Of all 17 cases, no patients were diagnosed with acute coronary syndrome. After removing CK-MB from the templates and requisitions, CK-MB and CK volumes decreased by 80% and 76%, respectively, translating to annual reagent cost savings of approximately $47000. CONCLUSIONS: Creatine kinase-MB can be removed from the routine ED test menu without adversely affecting patient care. In addition, substantial cost savings can be achieved by reducing unnecessary CK-MB testing and associated CK orders.
CONTEXT: Cardiac troponins T and I have replaced creatine kinase-MB (CK-MB) as the criterion standard for diagnosing myocardial injury. However, many laboratories still routinely perform a high volume of CK-MB testing in conjunction with troponin. PURPOSE: The purpose of this study is to study the clinical and financial impact of removing CK-MB from the routine emergency department (ED) test menu at a large academic medical center. METHODS: Creatine kinase-MB was removed from ED ordering templates and laboratory requisitions (ie, intervention), although the test could still be manually ordered. Data for creatine kinase (CK), CK-MB, and troponin T (TnT) specimens ordered during a 12-month period (6 months preintervention and 6 months postintervention) (n = 14571) was downloaded from our laboratory information system. All specimens with (1) normal TnT (ie, <0.01 ng/mL), (2) elevated CK-MB (ie, >6.6 ng/mL), and (3) elevated CK-MB index (ie, >5) were considered discrepant and independently reviewed by 2 ED clinicians for the presence of an acute coronary syndrome and for documentation of final diagnosis. Creatine kinase, CK-MB, and TnT ED volumes preintervention and postintervention were analyzed to assess laboratory cost savings. RESULTS: Of the 6444 cases included in the analysis, only 17 were discrepant. Of all 17 cases, no patients were diagnosed with acute coronary syndrome. After removing CK-MB from the templates and requisitions, CK-MB and CK volumes decreased by 80% and 76%, respectively, translating to annual reagent cost savings of approximately $47000. CONCLUSIONS: Creatine kinase-MB can be removed from the routine ED test menu without adversely affecting patient care. In addition, substantial cost savings can be achieved by reducing unnecessary CK-MB testing and associated CK orders.
Authors: Brian J Hachey; Michael C Kontos; L Kristin Newby; Robert H Christenson; W Frank Peacock; Katherine C Brewer; James McCord Journal: J Am Heart Assoc Date: 2017-09-22 Impact factor: 5.501
Authors: Sheharyar Raza; Andre C Amaral; Jeffrey Pang; Fuad Moussa; Dominick Shelton; Lowyl Notario; Heather Harrington; Jeannie L Callum; Paul M Yip Journal: BMJ Open Qual Date: 2020-12
Authors: Alan M Ducatman; Danyel H Tacker; Barbara S Ducatman; Dustin Long; Peter L Perrotta; Hannah Lawther; Kelly Pennington; Owen Lander; Mary Warden; Conard Failinger; Kevin Halbritter; Ronald Pellegrino; Marney Treese; Jeffrey A Stead; Eric Glass; Lauren Cianciaruso; Konrad C Nau Journal: Acad Pathol Date: 2017-05-28