Novis David A, Jones Bruce A, Dale Jane C, Walsh Molly K
Department of Pathology, Wentworth Douglass Hospital, Dover, NH 03820, USA.
Arch Pathol Lab Med. 2004 Feb;128(2):158-64. doi: 10.5858/2004-128-158-BMOMIT.
Rapid diagnosis of acute myocardial infarction in patients presenting to emergency departments (EDs) with chest pain may determine the types, and predict the outcomes of, the therapy those patients receive. The amount of time consumed in establishing diagnoses of acute myocardial infarction may depend in part on that consumed in the generation of the blood test results measuring myocardial injury.
To determine the normative rates of turnaround time (TAT) for biochemical markers of myocardial injury and to examine hospital and laboratory practices associated with faster TATs.
Laboratory personnel in institutions enrolled in the College of American Pathologists Q-Probes Program measured the order-to-report TATs for serum creatine kinase-MB and/or serum troponin (I or T) for patients presenting to their hospital EDs with symptoms of acute myocardial infarction. Laboratory personnel also completed detailed questionnaires characterizing their laboratories' and hospitals' practices related to testing for biochemical markers of myocardial injury. ED physicians completed questionnaires indicating their satisfaction with testing for biochemical markers of myocardial injury in their hospitals.
A total of 159 hospitals, predominantly located in the United States, participating in the College of American Pathologists Q-Probes Program.
Most (82%) laboratory participants indicated that they believed a reasonable order-to-report TATs for biochemical markers of myocardial injury to be 60 minutes or less. Most (75%) of the 1352 ED physicians who completed satisfaction questionnaires believed that the results of tests measuring myocardial injury should be reported back to them in 45 minutes or less, measured from the time that they ordered those tests. Participants submitted TAT data for 7020 troponin and 4368 creatine kinase-MB determinations. On average, they reported 90% of myocardial injury marker results in slightly more than 90 minutes measured from the time that those tests were ordered. Among the fastest performing 25% of participants (75th percentile and above), median order-to-report troponin and creatine kinase-MB TATs were equal to 50 and 48.3 minutes or less, respectively. Shorter troponin TATs were associated with performing cardiac marker studies in EDs or other peripheral laboratories compared to (1) performing tests in central hospital laboratories, and (2) having cardiac marker specimens obtained by laboratory rather than by nonlaboratory personnel.
The TAT expectations of the ED physicians using the results of laboratory tests measuring myocardial injury exceed those of the laboratory personnel providing the results of those tests. The actual TATs of myocardial injury testing meet the expectations of neither the providers of those tests nor the users of those test results. Improving TAT performance will require that the providers and users of laboratory services work together to develop standards that meet the needs of the medical staff and that are reasonably achievable by laboratory personnel.
对于因胸痛前往急诊科就诊的患者，急性心肌梗死的快速诊断可确定其接受治疗的类型，并预测治疗结果。确立急性心肌梗死诊断所耗费的时间可能部分取决于获取测量心肌损伤的血液检测结果所耗费的时间。
确定心肌损伤生化标志物的周转时间（TAT）规范率，并检查与更快TAT相关的医院和实验室操作。
参与美国病理学家学会Q-Probes项目的机构中的实验室人员，测量了因急性心肌梗死症状前往其医院急诊科就诊患者的血清肌酸激酶-MB和/或血清肌钙蛋白（I或T）从医嘱到报告的TAT。实验室人员还完成了详细问卷，描述其实验室和医院与心肌损伤生化标志物检测相关的操作。急诊科医生完成问卷，表明他们对所在医院心肌损伤生化标志物检测的满意度。
总共159家医院，主要位于美国，参与美国病理学家学会Q-Probes项目。
大多数（82%）实验室参与者表示，他们认为心肌损伤生化标志物从医嘱到报告的合理TAT为60分钟或更短。完成满意度问卷的1352名急诊科医生中，大多数（75%）认为，从他们开出检测医嘱之时起，测量心肌损伤的检测结果应在45分钟或更短时间内报告给他们。参与者提交了7020次肌钙蛋白和4368次肌酸激酶-MB检测的TAT数据。平均而言，他们报告称，从开出那些检测医嘱之时起，90%的心肌损伤标志物结果在略多于90分钟内得出。在表现最快的25%的参与者（第75百分位数及以上）中，肌钙蛋白和肌酸激酶-MB从医嘱到报告的中位TAT分别等于50分钟和48.3分钟或更短。与以下情况相比，较短的肌钙蛋白TAT与在急诊科或其他外周实验室进行心脏标志物检测相关：（1）在医院中心实验室进行检测；（2）心脏标志物标本由实验室人员而非非实验室人员采集。
使用测量心肌损伤的实验室检测结果的急诊科医生对TAT的期望超过了提供这些检测结果的实验室人员的期望。心肌损伤检测的实际TAT既未达到这些检测的提供者的期望，也未达到这些检测结果使用者的期望。提高TAT表现将要求实验室服务的提供者和使用者共同努力制定符合医务人员需求且实验室人员能够合理实现的标准。
