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snickers17 snickers17 (New Member) New Member

Troponin not flagged as critical?

Med-Surg   (1,294 Views 8 Comments)
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I work on a trauma floor, so I rarely see patients with serious cardiac issues. The other day was a crazy day and I had a patient who was in a minor car accident and was just being observed because of elevated Troponin levels. The ED told me the latest was 0.411. A couple hours later I saw a lab result that said the Troponin I was 1.01 but lab didn't call me and it wasn't even flagged as critical. The whole time I was assessing her/taking vitals on her as much as I can on the floor and she was fine. Obviously that's a concerning Troponin level and I'm worried I'll get in trouble since I didn't even see it for a while. Is it strange for a high Troponin I not to be flagged as critical?

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I would definitely follow-up with your unit leader and determine why this occurred. May be appropriate to investigate that as 1.01 is very, very high.

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Do you have an event reporting system? I would consider submitting an event report if you feel that this caused/could case a delay in care.

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I've seen this happen, where the lab did not call a positive troponin, but yet called a "panic chlamydia" result. I've also seen our lab delay results, even if you and the physician call asking for them, and then call a critical at say, 1600, then back time it in the chart up to two hours earlier so that it looks like it resulted at 1400. That being said, I don't think I've worked anywhere where the lab didn't seem to be...difficult and even shady at times, to say the least. Pharmacies are always frustrating too, but to a lesser degree, but I digress.

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Just yesterday I had one like this. I called lab for a stat serum glucose at 1130 that didn't result until 1530. I called multiple times for the results and was told "we are still working on it". Low and behold they time stamped a result of 628 at 1135. Needless to say, I did an occurrence report and a lot of charting about each time I called lab for my results.

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Our system time stamps the labs for the time they are ordered for, but you can hover over the column in question, or right-click the column and click activity (or something to that nature) and this will show the collection time and result time in real time. It's a pain in the rear especially since the docs do not "investigate" if the nurse is at fault for not relaying results or the lab was late with collections and testing results. Our lab calls us for just about everything. Hgb dropped 2 points but is still in normal range, they inquire if the patient has had surgery or receiving fluids etc. BUN started as 48 and now is 42, we get called, and the lab always takes the first and last name of the nurse that took the results for them to document the communication of results.

OP- I would complete an incident report on this, the delay in communicating those results could have affected the patient's care. There was a break down in the system somewhere and needs to be brought to the attention of those that can investigate and determine what happened. This provides an educational opportunity and could provide means to discovery in a system that is not flagging abnormal results as it should. This is not something that I have experienced as common practice where I have worked.

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Only the first positive troponin triggers a critical lab result reporting at every place that I've worked, there isn't really any reason to keep calling for subsequent 'positive' troponins since you already know their troponins are positive, and since troponins turn positive hours after the ischemic event and then stay elevated for hours to more than a day, there isn't any point in continuing to call to report a positive result.

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