The clinically effective use of cardiac markers by restructuring laboratory profiles at Cardiology wards

Background: Laboratory overutilization is associated with diagnostic error and potential patient risk. We applied a demand management strategy in collaboration with the local Department of Cardiology to reduce the cardiac markers high-sensitive troponin T (hsTropT) and N-terminal pro brain natriuretic peptide (NTproBNP) in laboratory ordering profiles (LOPs). The present study aimed to retrospectively evaluate the implemented strategies. Methods: Strategies included educational measures and evidence-guided, active test de-selection from all cardiology ward LOPs, and/or permanent removal from LOPs. Tests remained available at all times. We evaluated overutilization by reductions in monthly orders, and assessed differences in 30-day all-cause readmission rate and length of patients' hospital stay. Results: Overall, we observed a mean reduction of 66.1%+/- 7.6% (n=277 +/- 31) in hsTropT tests. Educational measures effectively reduced NTproBNP orders by 52.8% +/- 17.7% (n = 60 +/- 20). Permanent removal of tests from LOPs additionally decreased orders to a final extent of 75.8%+/- 8.0% (n =322 +/- 31) in NTproBNP tests. The 30-day readmission rate and overall length of hospital stay did not increase. Conclusions: Our results indicate that cardiac markers in routine care are subject to extensive overutilization when used within LOPs. Educational measures are an effective strategy to overcome the overutilization of cardiac markers but may be more effective when combined with the removal of cardiac markers from LOPs.