Tools and resources

Adoption support resource – insights from the NHS

Implementation

Implementation

Table 3 is a suggested implementation checklist which can be used locally to help guide the project team through the adoption process.

Table 3 Implementation checklist

Element

Checklist

Project start

Project leads identified:

  • clinical project champion

  • project lead or manager

  • project or management sponsor who will be able to help assess the financial viability of the project, ensure a business case is produced and help to show the potential cost savings.

Key stakeholders identified:

  • cardiologists

  • chest pain nurse specialists

  • emergency department doctors and senior nurses

  • doctors from the acute medical team

  • clinical biochemists.

Other internal stakeholders identified:

  • pharmacists

  • healthcare professionals working in the emergency department, acute medical units, cardiology and hospital laboratories

  • operational and finance management

  • clinical directors

  • commissioners.

Assess readiness

Current demand

  • How many people present to the emergency department with chest pain suspected to be caused by an acute coronary syndrome?

  • What percentage are discharged following rule out of non‑ST‑segment‑elevation myocardial infarction (NSTEMI) and what is their length of stay?

  • How many people is the technology suitable for (consider selection criteria, contraindications)?

Laboratory

  • Does the hospital laboratory have access to high-sensitivity troponin assays with the current service contract in place?

  • Which manufacturer currently provides the biochemistry platforms? Do they offer NICE-recommended high-sensitivity troponin assays?

  • When will the hospital laboratory be tendering for new equipment?

Care pathway mapping

  • What is the current care pathway? What actually happens? Where do people wait for troponin results? Who is involved (decision making, doing tasks)?

  • What are the current follow-up care and onward referral arrangements?

  • What is the potential effect on other specialities, for example medical admissions and cardiology, of adopting early rule-out protocols for NSTEMI using high-sensitivity troponin assays?

  • Do we know of any other sites who have done this or are planning it? How do we learn from them? Can we coordinate adoption with any local sites?

Cost

  • What are the anticipated costs and savings from adoption?

  • Is a business case needed and who is best placed to support this at a senior level and help overcome any financial barriers?

Measuring impact

  • What data do we currently collect for people presenting with chest pain suspected to be caused by an acute coronary syndrome?

  • Who is currently responsible for collecting these data?

Agreement to proceed

  • Business case developed and submitted?

  • Agreement to proceed based on value proposition?

Developing communications plans

  • Internal stakeholders engaged?

  • External stakeholders engaged?

Identify preferred assay

  • Engagement with manufacturers?

  • Service contracts discussed?

  • Assay validation checks completed?

  • Engaged with UKAS accredited external quality assurance service and internal and external quality assurance programme agreed?

  • Quality assurance samples for (internal quality assurance) containing low levels of troponin sourced?

Agree clinical pathway

  • Timings of troponin tests agreed?

  • Cut-off thresholds and delta changes agreed?

  • Risk scoring tool to support decision making selected?

  • Criteria for onward referrals agreed?

  • Pathway agreed across a region or locality?

Roll out training

  • Champion responsible for ensuring training for relevant staff groups?

  • Trainers identified?

  • Spread of training monitored?

Adoption into practice

  • Staff groups with responsibility for requesting high-sensitivity troponin assays identified?

  • Staff groups with responsibility for acting on high-sensitivity troponin assay results identified?

  • Strategies adopted to ensure blood tests are taken as soon as the protocol indicates?

  • Suitable location agreed for patients to wait for tests and results?

  • Discharge and onward referral protocols or criteria agreed?

Monitor performance

  • Audit lead identified?

  • Audit standards and audit plan written?

Measure impact

  • Agreement of service level measures to show impact on practice?

This page was last updated: