title: Utility of daily troponin orders for identifying acute myocardial infarction patients for quality improvement.
abstract: BACKGROUND
  Previous studies have demonstrated low rates of adherence to American College of Cardiology (ACC) and American Heart Association (AHA) guidelines for acute myocardial infarction (AMI). Quality improvement projects increase compliance with recommended therapies, but identification of AMI patients is a major challenge.
  
  
  OBJECTIVE
  To determine the utility of a daily troponin list in identifying AMI patients for a quality improvement initiative to increase compliance with ACC/AHA-recommended therapies.
  
  
  METHODS
  Quality improvement initiative.
  
  
  RESULTS
  During a 3-month period, the charts of patients with elevated troponin levels were screened for a diagnosis of AMI. For those patients with AMI, a clinical reminder about ACC/AHA-recommended therapies was placed in the chart. Nearly half (46%) of our hospital population had a troponin level measured during their clinical course. Of these, 26% had elevated troponin levels and 5% had AMI. All patients with AMI were identified using the daily troponin list with a sensitivity of 100% and a specificity of 78.4%. The daily troponin list captured more AMI patients than the admitting diagnosis. Use of the daily troponin list and targeted clinical reminders was associated with maintenance of a high (>95%) compliance with recommended therapies.
  
  
  CONCLUSIONS
  A daily list of inpatients with a positive troponin identified all patients with AMI. Targeted reminders to clinicians regarding ACC/AHA-recommended therapies for AMI were associated with consistent adherence to guideline-recommended therapies.
authors.affiliation: Pat and Jim Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT 06107, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Gronski
authors.forename: Wendy
authors.initials: W
authors.lastname: Martinson
authors.forename: Kanwar P
authors.initials: KP
authors.lastname: Singh
authors.forename: Jason
authors.initials: J
authors.lastname: Ryan
mesh_terms: D000368:Aged; D000572:American Heart Association; D005260:Female; D019983:Guideline Adherence; D006761:Hospitals / Q000592:standards; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D014336:Troponin / Q000097:blood*; D014481:United States
chemical_list: D014336:Troponin