Design, Implementation, and Outcomes for Point-of-Care Pathological Testing in a Cardiac Clinical Network

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The Integrated Cardiac Assessment Regional Network (referred to as the Network hereafter) was developed to facilitate the practice of evidence-based acute cardiac care by primary healthcare practitioners in rural South Australia. Timely access to biomarkers of cardiac myonecrosis was not available in most of these rural hospitals using traditional pathological laboratory services. The Network designed and implemented a pilot network in the southeastern region of South Australia based in part on point-of-care pathological testing (PoCT) for troponin. Troponin PoCT protocols were integrated with treatment and triage recommendations in clinical pathways for chest pain and acute coronary syndrome (ACS) management. Clinical decision making in the Network was further enhanced with improved access to consultant cardiologist advice 24 hours, 7 days per week. The Network commenced operations in 2001 with troponin as the only available PoCT. An appropriate training and quality framework matched to available local clinical resources were the essential components of PoCT implementation and ongoing operation. External quality assurance test results confirm successful implementation of PoCT in multiple health sites across a wide geographical area. Preliminary results comparing a regional hospital of the Network to control hospitals of similar size and resources show improved patient outcomes in the Network by significantly reducing the 30-day readmission rate for ACS from 10.4% to 4.2% (P = 0.03). A marked trend to reduction of ACS in-hospital death rates from 15.8% before the Network implementation to 9.8% after implementation was also observed. Point-of-care pathological testing has been critical to the success of the Network, however, needs are to be implemented within an integrated system of care to produce optimal outcomes.

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