Tools and resources

Adoption support resource – insights from the NHS

Potential barriers to implementation and mitigating action

Potential barriers to implementation and mitigating action

Table 1 summarises the key barriers to adoption gathered from the experiences and learning of contributors to this resource.

Table 1 Summary of the key barriers to adoption

Challenge

Suggested actions

Access to a recommended high-sensitivity troponin assay

Clinical biochemistry departments:

  • actively engage with emergency departments to share the benefits of high-sensitivity troponin assays if these are available

  • explore how to source recommended high-sensitivity troponin assays if these are not available. Check contracts for allowances for new tests when there is a clinical need

  • include the benefits of high-sensitivity troponin assays when tendering for service contracts.

Agreement between emergency department, cardiology, clinical biochemistry and acute medicine about the most appropriate early rule-out protocol

  • Identify a clinical champion with an interest in using high-sensitivity troponin assays for early rule out of non‑ST‑segment‑elevation myocardial infarction (NSTEMI), to engage colleagues in adoption.

  • Form a specialised implementation team to draft the early rule-out protocol. This will be a small group of senior representatives from the emergency department, cardiology, clinical biochemistry and acute medicine.

  • Use information from local validation testing of the assay and protocol to secure support from stakeholders.

Inappropriate testing reduces clinical confidence in the test

  • Use clear protocols defining which patients' high-sensitivity troponin assays should be used for the early rule out of NSTEMI.

  • Organise ongoing training and updates for staff responsible for ordering the test and record training.

  • Regularly audit practice against local guidance on who the assay should be requested for.

Allocation of resources

  • Work with trust finance staff to support any necessary business cases and redistribution of resources when needed.

  • Factor into finance planning that anticipated savings will be seen in emergency department, cardiology and acute medicine through quicker discharge. Costs are likely to be incurred by the laboratory for the assay and consumables and staff costs for the quality assurance work.

Measuring the impact of adoption

  • During adoption planning, identify the measures of success and agree who will be responsible for collecting and reporting this information. Agree how the information will be used.


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