Troponin testing: an audit in three metropolitan hospitals

Abstract

Objective: To audit the appropriateness of use of a troponin I assay in three hospitals.

Design: Cross-sectional survey of use of a troponin assay.

Setting: Three hospitals in Melbourne, Victoria, each with an emergency department and a coronary care unit.

Participants: Patients for whom a troponin I assay was requested between 1 and 7 May 2002, 27-42 months after introduction of the assay.

Interventions: User-focused dissemination of relevant information, including protocols for use, from opinion leaders when the assay was introduced; continuous reinforcement of information in pathology reports.

Main outcome measures: Adherence to protocol for assay use.

Results: Troponin assays were requested for 333 patients during 351 symptom episodes. A single assay was used in 194 symptom episodes (55%), and serial assays in 157 (45%); proportions were statistically indistinguishable across all three hospitals (chi(2); P = 0.71). Of the 194 single assays, 13 (7%) diagnosed a myocardial infarction. Serial troponin testing in all three hospitals followed the suggested protocol, with mean time between serial assays being more than 6 hours at all hospitals.

Conclusions: Adherence to the protocol for serial troponin assay intervals was adequate, but single troponin assays were used extensively and probably inappropriately.