Hospitals in pursuit of excellence

Lean/Six Sigma Methods Reduce Troponin Turnaround Time for Emergency Department Patients in a 500-Bed Tertiary Hospital Level I Trauma Center

National Academy of Clinical Biochemistry guidelines for biomarkers of acute coronary syndrome and heart failure emphasize a need for rapid turnaround time—within 60 minutes—for troponin results. Prolonged troponin test results may delay recognition of cardiac injury and the initiation of appropriate therapies.

A laboratory quality improvement project using Lean/Six Sigma methodology reduced the in-lab turnaround time for emergency department troponin results from a baseline of 55.4 (SD = 3.77) minutes to 33.2 (SD = 2.25) minutes. (Sigma scores before and after the improvements are 1.22 and 11.87 respectively.)

The improvement in troponin TAT allowed the laboratory to team with ED physicians averting a costly project, placing a point-of-care troponin platform in the ED, avoiding an estimated annual expense of $291,000.

This case study is part of the Illinois Hospital Association's annual quality awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals in continually improving and transforming health care in the state. These hospitals are improving health by striving to achieve the Triple Aim--improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Award recipients achieve measurable and meaningful progress in providing care that is:

• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient-centered

(The Institute of Medicine's six aims for improvement.)