Using the checklist (Example)

You are working with a multi-disciplinary group in your hospital. Using the checklist and pathway mapping as practical tools, define current practice and identify and evaluate the potential unmet clinical need for a new biomarker assay for rapid rule-out of non-ST-segment elevation myocardial infarction (NSTEMI).

Synopsis:

Background:
Acute Myocardial Infarction (MI) is part of a group of conditions including ST-segment elevation MI (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina that are collectively known as acute coronary syndrome.  When blood flow to the heart is blocked or reduced, cardiomyocyte damage occurs, leading to the release of cardiac biomarkers into the circulation.  The dynamic elevation of these biomarkers can differentiate diagnosis of Acute MI from unstable angina.
Patients generally present with chest pain, a symptom accounting for approximately 700,000 ED attendances per year in England and Wales, and over 250,000 emergency admissions per year.  In the UK, the Myocardial Ischaemia National Audit Project reported there were 79,433 admissions with acute MI recorded in England and Wales during 2011/12, 59% of which were categorised as NSTEMI. Current practice may result in approximately 2% of patients with acute MI being incorrectly discharged (NICE DG15, 2014).

Biomarkers:
Currently, the performance limitations of standard/conventional cardiac Troponin tests during the diagnostic workup of acute MI often necessitate admission to hospital while additional testing is undertaken. This has been shown to lead to unnecessary admission of low risk patients and costs to the health system for uneventful observations.  False-negative results by the conventional Troponin assays are also frequent, leading to incorrect patient discharge with increased readmission rate and 30- and 90-day mortality.  
Troponin assays with improved sensitivity have been developed to measure lower concentrations of this biomarker in the blood and help diagnose MI earlier than conventional assays. More sensitive assays enabling diagnostic results to be available to the clinician earlier would lead to shorter hospital stay for patients where ACS is excluded, and earlier intervention for those with confirmed NSTEMI.


Using the checklist and pathway mapping as practical tools, define current practice and identify and evaluate the potential unmet clinical need for a new high sensitivity Troponin assay for rapid rule-out of NSTEMI. 

Based on your evaluation using this checklist, please decide whether it is worthwhile implementing a higher sensitivity Troponin assay in your lab.

Upload the checklist (Word file template can be downloaded here) with your solutions of all steps (login and enrolment required). Alternatively, send the checklist with your solutions to Philip Monaghan.