Hanoi Medical University hospital (HMUH) receives approximately 3,500 patients per day, including around 100 patients per day in the Department of Emergency and Intensive Care (DEIC). One of the most important priorities for the DEIC is to triage patients with symptoms suggestive of acute coronary syndrome (ACS) as soon as possible. It is essential to make an appropriate clinical decision to rule-in for treatment or rule-out and continuously monitor in other departments rapidly.

Acute myocardial infarction (AMI) is a life-threatening condition. For patients presenting without persistent ST-segment elevation, the latest 2020 European Society of Cardiology (ESC) Guidelines for the management of acute coronary syndrome recommend patient classification and risk stratification with the 0h/1h hs-cTn  algorithm, with blood draw at 0h and 1h. hs-cTn assays should be used to ensure diagnostic accuracy, provide critical information for clinical decision making, and shorten the time interval of the second cardiac troponin assessment.

To tackle the potential challenges of managing a new workflow for DEIC, an integrated and customised Lab IT solution was created. This was enabled by the active collaboration between the HMUH Lab and the IVD Lab IT consultants. Blood samples from DEIC and high-sensitivity cardiac troponin (hs-cTn) testing were prioritised in order to obtain test results in the shortest time interval (less than 30 minutes).

The Lab IT solution enabled monitoring of patient results in an independent box by color coding with twin screens in both the lab and DEIC. The first hs-cTnT testing result (T0) will be reviewed and classified immediately. If a patient has T0 hs-cTnT < 5ng/L (blue boxes) or > 52ng/L (red boxes), the recommendation will be to rule-out or rule-in respectively.

If the results range from 5-52 ng/L (yellow boxes), the patient falls under the “observe zone” and needs to be monitored and is indicated for a second hs-cTnT testing (T1). Continued observation is recommended at levels (T1: 3 < 1h∆ < 5ng/L) and a re-test indicated at T3.

Non-ST-segment elevation myocardial infarction (NSTEMI) can also be ruled-out by the combination of low baseline levels (T0: 5-12 ng/L) and the lack of a relevant increase within 1h (1h∆ < 3) (blue boxes). Rule-in is recommended at high baseline levels (T0: 12 – 52 ng/L) and if 1h∆> 5 (red boxes).

“This Lab IT solution plays a pivotal role to save patient lives especially in the DEIC. These patients can now receive a rapid and accurate diagnosis with the appropriate treatment in a timely manner. Moving away from manual workflow to systematic solutions provides support to connect two departments into a single workflow, which enables the lab and clinicians to have reliable and useful information for better patient management and outcomes.” – Assoc Prof Hoang Van Hai, MD., Head of DEIC.

About Hanoi Medical University Hospital

Hanoi Medical University Hospital is a general hospital under Hanoi Medical University, developed based on the strengths of the University, established on 16th January, 2007 under Decision No. 137/QD-BYT of the Ministry of Health. At inception, the hospital’s facilities were basic, were only 150 beds and about 150 staff.

More than 14 years after establishment and continued development, Hanoi Medical University Hospital is now a large medical facility, and currently has more than 419 beds with more than 1000 staff. The doctors working here are all highly qualified and experienced (many are Professors, Associate Professors and PhDs).

The hospital currently has nearly 20 clinical specialties and 7 sub-clinical specialties to serve the needs of patients in regards to examination and treatment of multiple diseases. Hanoi Medical University Hospital is also one of the leading medical institutions in the application and development of high technology and new medical technology in Vietnam.