<<GUIDELINES FOR THE MANAGEMENT OF CHEST PAIN.doc>>

Further to the comments from David Parry, I enclose a copy of the protocol that we agreed with our A&E Consultant about a year ago and have been using ever since.

The rational for this is that on the ward there should be no problem with taking a second ample at 12-24 hours wheras we can't normally expect patients to stay in casualty for this length of time hence sample is taken at admission and 6 hours. If patient is discharged they are asked to return the following morning for a further blood test.

Repeat testing once sample is positive is discouraged but the message has to be reinforced regularly. It may sound expensive for the lab but the overall savings for CCU should be significant. No additional funding was provided for this service - it was funded from savings we achieved by going out to tender with 5 other labs for replacement analysers - however requesting of trop T has increased 4 fold since we started!

We have not audited the use of the policy since we started it - the A&E Consultant left 6 months ago because he was tired of being single -handed.