NCRHA goes high tech to ease ER congestion

Adult emergency patients and their families arriving at the Eric Williams Medical Sciences Complex, can look forward to less congestion, and a richer critical care experience as newly acquired technology is allowing doctors to more quickly and accurately diagnose heart patients.

“By rapidly confirming cardiac cases, doctors are now better positioned to interact with patients, to determine the critical actions needed to treat them at the ER with better outcomes and reduced congestion,” said Dr Ravi Lalla, head of the Accident & Emergency Department at the EWMSC.

He said the hospital has already reduced congestion in the ER by 57 percent last year and the addition of the new High Sensitivity Troponin Testing Machine will decrease congestion even further, by cutting more than 10 hours off cardiac diagnosis for emergency patients.

“This creates an opportunity to significantly reduce congestion in the ER, as up to 40 percent of serious cases coming to the ER are heart related,” he added. The patient experience is further improved as we will be able to narrow down their ailment and thus shorten the time they are in pain – and their stay in the hospital. If the test is positive for myocardial infarction (MI), they are immediately treated instead of waiting the additional 12 hours for older tests to confirm heart problems,” added Dr Lalla.

“This is a serious productivity tool for us in the ER, as it allows us to begin early treatment of patients with cardiac issues, and get them moving through the system towards the wards – or back home to their loved ones if their test result is negative.”

He said prior to this, patients would have to spend more than 12 hours under observation in the ER as we apply multiple tests to conclusively determine the cause of their chest pain.

“We have already started to use the new equipment to test troponin levels in patients with unexplained chest pains and the impact on the patient experience has been extremely positive. We now have the technology to make early decisions based on the results – to apply the right medications and treatments to patients fast enough to save lives and reduce congestion and unnecessary stay overs at the hospital,” he added.

“Chest discomfort is one of the most common diagnoses we see in the emergency room, and having a more sensitive test to identify or exclude acute myocardial infarction (MI) – or heart attacks, is a big step towards clearing emergency room congestion,” he added.

Troponins are protein molecules that are part of cardiac and skeletal muscle. Troponin is released by the heart muscle when it encounters an adverse event such as trauma or when heart muscle begins to die during a MI event. The more severe the event, the more troponin is released into the bloodstream.

The ER at the EWMSC already has equipment that tests troponin levels in patients, but this often takes more than 12 hours with repeated tests to get a confirmed reading. Dr Lalla said the new high sensitivity machine is able to detect troponin levels that are ten times lower than previously available – and within 2 hours, so it can detect MI events long before they manifest into major cardiac events. He said, with the right diagnosis, we can urgently begin addressing the right problems with the right treatments early in the process.

He said just as important as the capability of the troponin machine to detect early MI issues, it can also clearly confirm when a patient isn’t having a cardiac event, so we can begin addressing the real source of the patient’s complaints. A confirmed heart patient is usually kept for observation as we address their medical issues, but if we are able to rule out heart problems early, we can address other problems quickly and move them out of the ER with the right treatments they need.

Patients have been noticing the improvements we have been making in the local healthcare system over the past year, and the EWMSC has been taking the lead to deliver the kind of experiences and care that our citizens have been asking for, said Health Minister, Hon. Terrance Deyalsingh.

“A lot of this has to do with introducing the latest proven healthcare technology such as this new troponin array, and making improvements to the system so we can increase the number of patients we take care of in the ER.

“Over the past few months, the Adult Accident & Emergency Department at the Mt Hope hospital has been upgraded to improve the environment and facilities, the layout has also been changed to better facilitate communication with patients and their families. Patients now have easier access to the medical staff for information and records, while medical staff are better able to manage patients based on their emergency.

“Security has also been improved, and we have a platform to take it further by upgrading the technology to save lives and deliver care faster to patients. We have changed our focus to put the spotlight on our patients. They are noticing our efforts and are enjoying the benefits of this,” added Minister Deyalsingh.

The high sensitivity troponin machine is the first of its kind in Trinidad and Tobago, and the southern Caribbean, and it was only approved as a critical test for cardiac patients in January 2017 by the U.S. Food and Drug Administration. High sensitivity troponin arrays are quickly becoming a standard test used in many first world countries to confirm early diagnosis of MI in the emergency room.

“This means that the EWMSC is at the cutting edge of medical technology in Trinidad and the wider Caribbean – making us the premium local healthcare services provider,” said Davlin Thomas, Chief Executive Officer (Ag) at the North Central Regional Health Authority.

“The High Sensitivity Troponin Machine will allow us to take care of our patients 10 hours earlier than in the past, so action can begin well before muscle damage in the heart becomes critical. From the patients’ point of view, there will be further reductions in congestion to match the successes we have already achieved since 2016.

“This technology is only now being introduced in North America, Europe, Japan and Australia, so if you are having chest pains in Trinidad and Tobago, the best place to be right now is the Emergency Room at the EWMSC,” he added.

“We are committed to bringing the best world classed technology to the patients under our care, and technology such as the High Sensitivity Troponin Testing Machine is part of our wider strategy to improve our entire system to more effectively deliver quality healthcare.

“We are applying appropriate technology to improve the patient experience, minimize their discomfort and the uncertainty that often comes with hospital care. Other recent healthcare technology acquisitions such as the new Endoscopy Suite, the Colposcopy Centre, new MRI equipment, as well as important digital support systems to deliver faster access to lab results and medical records, has positioned the EWMSC, Mt Hope, as the premier health facility in the southern Caribbean, and we are committed to delivering first-world quality care to all our patients, added Thomas.

We also acknowledge that the long term solution is to aggressively take on the lifestyle issues that cause heart disease, hypertension, diabetes, stroke and other non-communicable diseases (NCDs) through our “Walk The Talk” and “In-Touch” programs. These programs have tackled the underlying issues that cause many people to visit the Emergency Room, by reaching out to patients in their communities, places of worship and often in their homes, to monitor their progress, educate them about the need for exercise, proper diet and other habits that will improve their quality of life.


The High Sensitivity Troponin machine will reduce congestion by:

  • Delivering reliable results, 10 hours faster
  • Reducing demand for beds and stays overs
  • Facilitate richer patient/doctor interactions
  • Increasing premium quality patient experience trop mach1
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