Reducing redundant creatine kinase testing in cardiac injury
- Resource Type
- Authors
- Paul M. Yip; Dominick Shelton; Lowyl Notario; Jeffrey Pang; Heather Harrington; Andre Carlos Kajdacsy-Balla Amaral; Fuad Moussa; Jeannie Callum; Sheharyar Raza
- Source
- BMJ Open Quality
BMJ Open Quality, Vol 9, Iss 4 (2020)
- Subject
- laboratory medicine
medicine.medical_specialty
Heart Diseases
Leadership and Management
Cost effectiveness
030204 cardiovascular system & hematology
Academic detailing
03 medical and health sciences
0302 clinical medicine
Internal medicine
Humans
Medicine
030212 general & internal medicine
Creatine Kinase
cost-effectiveness
Original Research
lcsh:R5-920
biology
business.industry
Health Policy
Public Health, Environmental and Occupational Health
Healthcare quality improvement
Troponin
Audit and feedback
biology.protein
Clinical value
audit and feedback
Creatine kinase
lcsh:Medicine (General)
healthcare quality improvement
business
Biomarkers
Biomedical sciences
- Language
- ISSN
- 2399-6641
BackgroundCreatine kinase (CK) testing in the setting of suspected cardiac injury is commonly performed yet rarely provides clinical value beyond troponin testing. We sought to evaluate and reduce CK testing coupled with troponin testing by 50% or greater.MethodsWe performed root cause analysis to study prevailing processes and patterns of CK testing. We developed new institutional guidelines, removed CK from high-volume paper and electronic order bundles and conducted academic detailing for departments with highest ordering frequency. We evaluated consecutive patients at Sunnybrook Health Sciences Centre between 1 January 2018 and 31 March 2020 who had either a CK or troponin level measured. We prespecified successful implementation as a reduction of 50% in total CK orders and a decrease in the ratio of CK-to-troponin tests to one-third or less. We retained additional data beyond our study period to assess for sustained reductions in testing.ResultsTotal CK tests decreased over the study period from 3963 to 2111 per month, amounting to a 46.7% reduction (95% CI 33.2 to 60.2; pConclusionsWe demonstrate that a low-cost and feasible quality improvement initiative may lead to significant reduction in unnecessary CK testing and substantial savings in healthcare costs for patients with suspected cardiac injury.