Background: We previously reported that a high number of synacthen tests are carried inaccurately within our trust with a significant delay in sample collection after tetracosactide injection. We also reported a high number of patients having Synacthen tests unnecessarily. In light of this we introduced a Synacthen proforma and re-audited our results.
Method: A retrospective study was carried out on 36 patients undergoing Synacthen tests between October 2015 and August 2016. Patient records were reviewed to see if a prior cortisol had been measured and the accuracy of the sample timings within the SST were evaluated. The results were compared to original audit data.
Results: There was a significant reduction in the number of Synacthen tests being performed following policy change (0.80 tests/week vs. 1.29 tests/week; P=<0.01). There was an associated increase in number of patients having cortisol levels measured prior to commencing an SST (27/36, 75% vs. 168/322, 52%; P=<0.01). A reduction in the proportion of tests being undertaken inaccurately was seen following the introduction of the new policy (12/36, 33% vs. 196/336, 58%: P=<0.01). There was a significant improvement in the timing of the samples in those that used the proforma. 30 minute median sample time = 30 minutes (IQR 29/32; range 27-52) vs. 35 minutes (IQR 3045; range 13197) P=<0.01. 60 minute median sample time = 63 minutes (IQR 6065; range 5781) vs. 65 minutes (IQR 6075; range 30198) P=0.05.
Conclusion: The introduction of a synacthen proforma has resulted in a reduction in inappropriate synacthen tests and an improvement in the accuracy of sample collection making result interpretation more reliable.