Four innovations will be fast-tracked into use in the NHS through the Innovation and Technology Payment 2019/20 programme, supported by the AHSN Network. One of these is Elecsys Troponin.

Roche Elecsys® Troponin T-hs test

Challenge/problem identified

Chest pain, with the suspicion of myocardial infarction (MI or heart attack), is responsible for around 700,000 emergency department attendances per year and over 253,765 emergency admissions in England and Wales. This accounts for approximately 5% of all emergency admissions.

However, only approximately 20% of emergency admissions for chest pain will be diagnosed with MI. Therefore, it is important to diagnose true MI cases as early as possible to ensure access to effective treatment for patients who need it. In parallel, it is also crucial to discharge non-MI cases to avoid unnecessary hospital admissions.

With the current pressures on the emergency department (ED), there is a great need for tools that can support quicker discharge from the ED.

Roche TroponinSolution

The Roche Elecsys® Troponin T-hs (TnT-hs) test supports a faster diagnosis of acute myocardial infarction (MI or heart attack). Two blood tests are performed one or three hours apart compared to standard testing (10-12 hours apart). This supports an earlier detection of acute MI within four hours of presentation at the ED, as long as test results are rapidly available and a final clinical decision is based on multiple factors.

This improvement in time-to diagnosis enables a more efficient allocation of resources, by reducing the fines paid by trusts for delayed discharge from the ED and potentially by reducing unnecessary hospital admission. It also improves patient experience by reducing time-to-discharge and by targeting the right care to the true MI cases.

Impact

Implementing the Roche Elecsys® high-sensitivity troponin test would:

  1. Improve the management of patients and patient experience. Studies demonstrated that rapid TnT-hs testing can reduce time-to-discharge: >75% of patients were rapidly ruled ‘out’ or ‘in’ in the ED and approximately 70% were safely sent home.
  2. Improve clinical confidence as “it is likely that high-sensitivity troponin testing will detect additional people who would benefit from treatment in practice.”
  3. Lead to the application of a validated rapid protocol and the NICE DG15 guidance.
  4. Standardise care which would reduce length of stay in the ED and improve compliance with the four-hour discharge from the ED target. Currently, “16.5% of hospital A&E attendees spent longer than 4 hours in the department in 2017, compared with 5.6% in 2012”.
  5. Produce cost savings. An economic evaluation found that the implementation of the one-hour TnT-hs protocol resulted in a reduction of 46% in total costs per patient compared to standard practice.

 

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