title: Decreasing troponin turnaround time in the emergency department using the central laboratory: A process improvement study.
abstract: OBJECTIVE
  To implement collaborative process improvement measures to reduce emergency department (ED) troponin turnaround time (TAT) to less than 60min using central laboratory.
  
  
  METHODS
  This was an observational, retrospective data study. A multidisciplinary team from the ED and laboratory identified opportunities and developed a new workflow model. Process changes were implemented in ED patient triage, staffing, lab collection and processing. Data collected included TAT of door-to-order, order-to-collect, collect-to-received, received-to-result, door-to-result, ED length of stay, and hemolysis rate before (January-August, 2011) and after (September 2011-June 2013) process improvement.
  
  
  RESULTS
  After process improvement and implementation of the new workflow model, decreased median TAT (in min) was seen in door-to-order (54 [IQR43] vs. 11 [IQR20]), order-to-collect (15 [IQR 23] vs. 10 [IQR12]), collect-to-received (6 [IQR8] vs. 5 [IQR5]), received-to-result (30 [IQR12] vs. 24 [IQR11]), and overall door-to-result (117 [IQR60] vs. 60 [IQR40]). A troponin TAT of <60min was realized beginning in May 2012 (59 [IQR39]). Hemolysis rates decreased (14.63±0.74 vs. 3.36±1.99, p<0.0001), as did ED length of stay (5.87±2.73h vs. 5.15±2.34h, p<0.0001). Conclusion Troponin TAT of <60min using a central laboratory was achieved with collaboration between the ED and the laboratory; additional findings include a decreased ED length of stay.
authors.affiliation: St. John Hospital and Medical Center, Department of Emergency Medicine, 22101 Moross Road, Detroit MI 48236, USA. Electronic address: arlene.boelstler@stjohn.org.
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Boelstler
authors.affiliation: St. John Hospital and Medical Center, Department of Laboratory Services, 22101 Moross Road, Detroit MI 48236, USA. Electronic address: ralph.rowland@stjohn.org.
authors.forename: Ralph
authors.initials: R
authors.lastname: Rowland
authors.affiliation: St. John Hospital and Medical Center, Department of Emergency Medicine, 22101 Moross Road, Detroit MI 48236, USA. Electronic address: jennifer.theoret@stjohn.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Theoret
authors.affiliation: St. John Hospital and Medical Center, Department of Emergency Medicine, 22101 Moross Road, Detroit MI 48236, USA; Wayne State University School of Medicine, 540 E Canfield Street, Detroit, MI 48201, USA. Electronic address: robert.takla@stjohn.org.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Takla
authors.affiliation: St. John Hospital and Medical Center, Dept. of Medical Education, Detroit MI 48236, USA. Electronic address: susan.szpunar@stjohn.org.
authors.forename: Susan
authors.initials: S
authors.lastname: Szpunar
authors.affiliation: St. John Hospital and Medical Center, Department of Emergency Medicine, 22101 Moross Road, Detroit MI 48236, USA. Electronic address: nenomole@gmail.com.
authors.forename: Shraddha P
authors.initials: SP
authors.lastname: Patel
authors.affiliation: St. John Hospital and Medical Center, Department of Emergency Medicine, 22101 Moross Road, Detroit MI 48236, USA. Electronic address: andrew.lowry@providence-stjohnhealth.org.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Lowry
authors.affiliation: St. John Hospital and Medical Center, Department of Emergency Medicine, 22101 Moross Road, Detroit MI 48236, USA; Wayne State University School of Medicine, 540 E Canfield Street, Detroit, MI 48201, USA. Electronic address: margarita.pena@stjohn.org.
authors.forename: Margarita E
authors.initials: ME
authors.lastname: Pena
mesh_terms: D004636:Emergency Service, Hospital / Q000592:standards*; D006801:Humans; D007755:Laboratories, Hospital / Q000592:standards*; D007902:Length of Stay / Q000639:trends; D017064:Process Assessment, Health Care / Q000379:methods / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*; D012189:Retrospective Studies; D013997:Time Factors; D014336:Troponin / Q000097:blood*; D057188:Workflow
chemical_list: D014336:Troponin
keywords: Central laboratory; Emergency department; Process improvement; Troponin; Turnaround time