Hi there,
We don't have critical values for our troponins.
However, we have recently been asked by the emergency department to phone
troponins over 100 ng/L. One reason was that with crowding the emergency
department, physicians are often handling multiple patients, and no longer
have a printed result being handed to them by a unit clerk who recognizes the
importance of an abnormal troponin. Because no troponin value is "critical,"
it does not even result in a red flag on the EDIS computer tracking screen.
Moreover, chest pain patients may be in a hallway, or indeed still in the
waiting rooms, when the troponin is resulted, sad but true.
During the above request, it was mentioned that venous blood gas pO2's of < 35
mmHg were being flagged as critical and thus contributing to the alarm fatigue
of red flags/phone calls. So we were able to remove these flags and address
this issue.
As we expect about 5 calls to be needed a day, we are doing a trial of calling
Trops > 100 ng/L (the first one on a patient) to the emergency department only
over the next few months.
Cheers,
Christine
C. Collier, PhD FCACB,
Clinical Chemistry,
Kingston General Hospital,
Ontario, Canada
------------------------------ Original Message ------------------------------
Subject: Re: Telephoning Cardiac Troponin results
From: "Andrew Lyon" <[log in to unmask]>
Date: Wed, December 16, 2015 10:05 am
To: [log in to unmask]
------------------------------------------------------------------------------
Our laboratories serve a network of three hospitals as well as a large volume
of test requests for ambulatory community-based outpatients.
We do not phone troponin results for patients in the hospitals (e.g. troponin
tests are not on our critical test list).
We have a few small number of troponin requests for community-based
outpatients. If those troponin results are >50 ng/L, (presumably unexpected !)
the results are phoned to the community-based physicians that ordered the
test.
regards, Andrew
Dr. A. Lyon
Saskatoon Health Region,
Saskatoon, SK, Canada.
----- Original Message -----
From: Bosomworth Mike (LEEDS TEACHING HOSPITALS NHS TRUST)
<[log in to unmask]>
To: [log in to unmask]
Sent: Wed, 16 Dec 2015 03:52:46 -0700 (MST)
Subject: Telephoning Cardiac Troponin results
Dear All, I am being put under pressure to agree to telephone out all high
cardiac troponin (cTn) results. Do other labs do this and if so at what level
(please include your diagnostic cut off value for ACS if you do and you
respond)? If we were to telephone out all raised TnI results i.e. those > 50
ng/L I calculate that it would take over 2 hours which is clearly not
feasible, or at least not with existing resources. Thank you in anticipation
of your help. With best wishes for Christmas and the New Year.
Mike
Dr Mike Bosomworth
Clinical Service Lead for Blood Sciences and Specialist Laboratory
MedicineConsultant Clinical Biochemist
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