Hi Fiona
We do the same as Mike as our geography is also very rural, and even though we haven't formally evaluated the service the general perception is that it is beneficial to the patient.

Hope this helps?

 
Avril
 
Avril Wayte
Consultant Biochemist
Clinical Biochemistry
Ysbyty Gwynedd
Bangor
Clinical Director for Biochemistry, BCUHB
Chair RCPath WRC
01248 384262
 
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Hallworth Mike (RLZ)
Sent: 06 September 2013 10:59
To: [log in to unmask]
Subject: Re: Troponin for GP patients

It depends to some extent on your geography. In rural areas, where
patients may be 20 or 30 miles away from A&E, GPs find it helpful to
check Tn in chest pain which isn't obviously cardiac.
We look out for them, do them as soon as possible after receipt
(certainly same day) and phone the GP out of hours service if raised.

Mike





-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of Fiona Davidson
Sent: 06 September 2013 10:54
To: [log in to unmask]
Subject: Troponin for GP patients

Dear All,

Are there any labs out there who DON'T offer troponin to their GPs?  

We are querying whether it is all that helpful - if a patient appears
clinically to have had an MI then surely they should be going straight
to A&E?  GPs rarely mark samples as urgent and even those that do very
often get missed at specimen reception and so get stuck amongst the
hundreds of other GP samples waiting to be processed.  Once they finally
make it onto the analyser and a result is produced it often isn't phoned
because the BMS' tend to assume that all raised troponins are hospital
patients (which don't get phoned out).  All in all the whole process can
take at least a day and a half or up to 3 days if the sample came in on
a Friday.

Add to this the fact that troponin is reportedly only stable for 24
hours and I'm not sure we are offering a particularly useful service
here.  

When I have gone back and looked at the patients who had a GP raised
troponin it didn't look like many of them were followed up with a second
sample or even a hospital admission.  The majority of these are only
slightly raised ? due to e.g. CKD.

So my question is: would these patients be better served if we didn't
offer GP troponin so that all those with a high probability of MI come
straight to hospital?  Has anybody done any work on this?

Thanks

Fiona Davidson
Senior Biochemist
Kingston Hospital NHS Trust

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