Effectively Reducing CK-MB Utilization Using Computer Order Entry in the Emergency Department

Sullivan, Paul; Waymack, James R.; Griffen, David; Jaeger, Cassie

doi:10.1177/1062860616657149

Cited by 6 publications

(5 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Multiple other groups, including Mayo Clinic, simply removed CK-MB from routine order sets and found 80.0% to 99.8% reductions in CK-MB orders with significant cost savings and without negative impact on patient care or missed AMI diagnoses. 8,12, [43][44][45][46] Implementation Blueprint: Eliminating CK-MB Testing With clear evidence to support elimination of CK-MB from clinical care for the diagnosis of ACS and based on experience eliminating CK-MB at our respective institutions, we devised a blueprint for other institutions to use in enacting quality improvement initiatives. The methodology and theory of the blueprint and quality improvement initiative are based on the US Health Resources and Services Administration strategies for developing and implementing a quality improvement initiative, with a focus on education, action, and…”

Section: Safety and Quality Outcomes Data: Eliminating Ck-mb Testingmentioning

confidence: 99%

“…Multiple academic medical centers have implemented interventions to eliminate the routine ordering of CK-MB and measured associated cost savings and impact on patient safety (Table). Larochelle et al recorded data on patients with suspected ACS (n = 60 494 patients preintervention; n = 24 341 patients postintervention) over a period of 43 months (31 months preintervention; 12 months postintervention). They initially developed an institutional guideline in collaboration with cardiologists to specify appropriate ordering of cardiac biomarkers for the diagnosis of AMI.…”

Section: Safety and Quality Outcomes Data: Eliminating Ck-mb Testingmentioning

confidence: 99%

“…In addition, they noted fewer orders after searches and fewer searches for CK-MB over this time, arguing for a long-term educational benefit for the BPA. Multiple other groups, including Mayo Clinic, simply removed CK-MB from routine order sets and found 80.0% to 99.8% reductions in CK-MB orders with significant cost savings and without negative impact on patient care or missed AMI diagnoses …”

Section: Safety and Quality Outcomes Data: Eliminating Ck-mb Testingmentioning

confidence: 99%

See 2 more Smart Citations

Eliminating Creatine Kinase–Myocardial Band Testing in Suspected Acute Coronary Syndrome

et al. 2017

View full text Add to dashboard Cite

Section: Safety and Quality Outcomes Data: Eliminating Ck-mb Testingmentioning

confidence: 99%

Section: Safety and Quality Outcomes Data: Eliminating Ck-mb Testingmentioning

confidence: 99%

Section: Safety and Quality Outcomes Data: Eliminating Ck-mb Testingmentioning

confidence: 99%

See 1 more Smart Citation

Eliminating Creatine Kinase–Myocardial Band Testing in Suspected Acute Coronary Syndrome

et al. 2017

View full text Add to dashboard Cite

“…Other studies have shown CK/CK-MB does not add value to the determination of myocardial injury, and the correlation between CK-MB and the reduction of mortality is not statistically significant [11][12][13].…”

Section: Discussionmentioning

confidence: 88%

“…This study is one of few that evaluated the safety of removing CK-MB and replacing it with troponin [ 10 ]. Other studies have shown CK/CK-MB does not add value to the determination of myocardial injury, and the correlation between CK-MB and the reduction of mortality is not statistically significant [ 11 - 13 ]. Eliminating CK/CK-MB from the diagnosis of ACS does not negatively impact the patient and is not associated with significant missed diagnoses, but is associated with significant savings.…”

Section: Discussionmentioning

confidence: 99%

The Best of Both Worlds: Eliminating Creatine Kinase-Muscle/Brain (CK-MB) Testing in the Emergency Department Leads to Lower Costs Without Missed Clinical Diagnoses

Sahadeo¹,

Dym²,

Berry³

et al. 2021

Cureus

View full text Add to dashboard Cite

The 2014 American Heart Association/American College of Cardiology (AHA/ACC) clinical guidelines recommend cardiac troponin as a superior biomarker to creatine kinase (CK) and creatine kinase-muscle/brain (CK-MB) for the detection of acute coronary syndrome (ACS), namely myocardial infarction and unstable angina. In April 2018, our Emergency Department (ED) transitioned from using standard troponin to using high-sensitivity troponin T, and adopted a clinical guideline consistent with the AHA/ACC. The guideline recommended high-sensitivity troponin T without CK/CK-MB testing in the majority of clinical situations, limiting CK/CK-MB testing to two specific clinical cases: 1) estimated glomerular filtration rate (eGFR) value <15 mL/min, or 2) recent acute coronary syndrome (ACS) event. Per our ED’s policy, a “negative” troponin T was defined as being below the limit of detection (LOD) (i.e., <6 ng/L); such a value obtained at least 3 hours after symptom onset “ruled out” an ACS event and did not require a repeat troponin. The goal of this retrospective study was to determine whether the guideline limiting CK-MB testing missed clinically-significant cardiac outcomes (ACS or new diagnosis of coronary artery disease [CAD]) or was associated with mortality. Pre-implementation data (July 1, 2017 - December 31, 2017) was compared with post-implementation data (July 1, 2018 - December 31, 2018). After guideline introduction, CK/CK-MB ordering decreased by nearly 90%, while troponin ordering increased by nearly 20%, likely due to the introduction in June 2018 of high-sensitivity troponin T, which yielded numerous intermediate/indeterminate-range results that prompted repeat testing. Fewer than 1.5% of patients with a “negative” troponin (below the LOD) and a “positive” CK-MB (above the upper limit of normal [ULN]) had ACS or new-diagnosis CAD; patients with either diagnosis did not expire during their hospital stay or within 30 days of their index visit. CK-MB Index, which has a higher specificity than CK, only found ACS or new CAD among 0.8% of positive results. Considering both decreased CK/CK-MB and increased troponin ordering, the net annual direct cost savings in cardiac biomarker testing was extrapolated to $12,700. Had our institution not transitioned to higher cost high-sensitivity troponin ($2.054/unit) from standard troponin ($1.65/unit), and had the rate of troponin ordering increased solely proportionate to the rate of ED visit increase (2% year-over-year) rather than increase nearly 20% (likely due to the transition to high-sensitivity troponin), then the total six-month direct costs on troponin testing would have been $14,632 instead of $21,267.12, and annual direct cost savings would have been $18,945.80 instead of $12,700. The new ED clinical guideline did not result in a significant number of missed ACS or new-diagnosis CAD, and was associated with direct cost savings. These savings probably underestimate total savings, as the reduced number of “false-positive” CK-MB results likely prevente...

show abstract

Rationalisation de la prescription des examens biologiques : état des lieux en réanimation

Ben Souissi,

Haddad,

Mebazaa

2024

Anesthésie & Réanimation

View full text Add to dashboard Cite

Effectively Reducing CK-MB Utilization Using Computer Order Entry in the Emergency Department

Cited by 6 publications

References 5 publications

Eliminating Creatine Kinase–Myocardial Band Testing in Suspected Acute Coronary Syndrome

Eliminating Creatine Kinase–Myocardial Band Testing in Suspected Acute Coronary Syndrome

The Best of Both Worlds: Eliminating Creatine Kinase-Muscle/Brain (CK-MB) Testing in the Emergency Department Leads to Lower Costs Without Missed Clinical Diagnoses

Rationalisation de la prescription des examens biologiques : état des lieux en réanimation

Contact Info

Product

Resources

About