Dr Lee Chien-Chang
Deputy Director of Intelligent Healthcare and Professor of Emergency Medicine, National Taiwan University Hospital, Taiwan

Tips for implementing ESC high sensitivity cardiac troponin (hs-cTn) rapid algorithms for triage of AMI patients


  • Strategies to increase adoption of hs-cTn in the ED include education, re-engineering of ED and laboratory processes as well as information technology.
  • Contributing factors to successful implementation include knowledgeable ED physicians and support from hospital administration.
  • Rapid algorithm transition in the ED requires short turnaround time for the assays from the lab, ED physicians to know the cut-off interpretation and IT support.

Q1 What in your opinion are some strategies to increase the adoption of the rapid algorithms in the emergency departments (EDs) across Asia Pacific (APAC)?

Three strategies are needed to increase the adoption of rapid algorithm in EDs across APAC. These strategies include education, re-engineering of ED and laboratory processes, and using information technology to aid decision making. Physicians and all supporting staff involved in the care of chest pain patients should be educated on the 0/1-hour algorithm as they need to work as a team to implement the algorithm.

Q2 What would be the contributing factors to a successful implementation?

A knowledgeable ED physicians to lead the transformation of AMI triage process and support from hospital administration are two key factors for successful implementation.

Q3 What is your experience using the rapid algorithms in the ED in your institution?

To use a rapid algorithm, we first meet with the laboratory team and ensure that the turnaround time for hs-cTn be less than 30 minutes. We then educate our physician and nursing staff. We are developing a decision support system with the information team to remind the physicians about the appropriate cutoffs and actions based on the troponin levels at a certain time point. I would conclude, the key to a successful implementation of rapid algorithm in the ED is leadership, education, process engineering, and information technology.

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