Real-world impact of implementing a point-of-care high-sensitivity troponin pathway on emergency department flow

Q: What are the key findings of this study?

Implementing a point-of-care high-sensitivity troponin pathway reduced mean emergency department length of stay by 67 minutes compared to standard laboratory testing.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Suspected acute coronary syndrome (n=1381). Intervention: Point-of-care high-sensitivity cardiac troponin I testing (0-2 hour pathway) vs. Central-laboratory testing (0-3 hour pathway). Primary outcome: Emergency department length of stay (LOS) (MD -67 minutes, 95% CI -92.8 to -41.3, p=<0.001).

Q: What does this research mean for the field?

Implementing a point-of-care high-sensitivity cardiac troponin pathway with a 0-2 hour serial-sampling interval significantly reduces emergency department length of stay and 4-hour breaches. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the real-world operational impact of replacing laboratory-based cardiac troponin testing with an accelerated bedside point-of-care pathway on emergency department length of stay.

Faheem Ahmad; Usmaan Razzaq; Vaishnavi Muthukrishnan; Angela Burns; Katriona Brooksbank; Louise Boughen; Ian Godber; Andrew Saunders

doi:10.1177/00369330261481425

September 3, 2026ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam)Open Access

Real-world impact of implementing a point-of-care high-sensitivity troponin pathway on emergency department flow

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Key result

Point-of-care hs-cTnI pathway linked to ~67-minute reduction in emergency department length of stay.

MD -67 minutes
95% CI -92.8 to -41.3
P<0.001
n=1,381

Why the study?

POC hs-cTnI testing can reduce diagnostic turnaround in the ED, but real-world operational data remain mixed.

Does a point-of-care high-sensitivity troponin pathway with a shortened serial-sampling interval reduce emergency department length of stay in adult patients undergoing troponin testing?

Key Points

To assess the real-world operational impact of replacing laboratory-based cardiac troponin testing with an accelerated bedside point-of-care pathway on emergency department length of stay.
Conducted an observational before-after service evaluation involving 1381 adult attendances (718 pre-implementation, 663 post-implementation) at a high-volume UK tertiary emergency department.
Implemented a new chest-pain pathway combining bedside point-of-care hs-cTnI testing (Abbott i-STAT Alinity) with a reduced serial-sampling interval from 0-3 to 0-2 hours via a hard switch.
Evaluated emergency department length of stay and four-hour breach rates using Wilcoxon testing and segmented interrupted time series analysis.
Overall median length of stay dropped from 382 to 319 minutes (-63 minutes; p < 0.001), while among serial-testing patients it decreased from 510 to 335 minutes (-175 minutes; Wilcoxon p < 0.001).
The four-hour breach rate fell from 78.8% to 67.3% overall (-11.6 percentage points; 95% CI -16.2 to -6.9; p < 0.001) and dropped from 95.7% to 72.7% among serial-testing patients (-23.0 percentage points; 95% CI -29.7 to -16.3).
Interrupted time series analysis showed an immediate step-change at implementation of -144 minutes (95% CI -219 to -67; p < 0.001), releasing an estimated theoretical capacity of ~51 bed-hours per day.

Study Design

Type

Observational (n=1,381)

Multicenter

No

Structured PICO

Does a point-of-care high-sensitivity troponin pathway with a shortened serial-sampling interval reduce emergency department length of stay in adult patients undergoing troponin testing?

P

Population

1,381 adult emergency department attendances with suspected acute coronary syndrome undergoing troponin testing, evaluated before and after implementation of a point-of-care pathway.

I

Intervention

New chest-pain pathway combining bedside point-of-care (POC) high-sensitivity cardiac troponin I (hs-cTnI) testing with a reduction in the serial-sampling interval from 0-3 to 0-2 hours.

C

Comparator

Central-laboratory hs-cTnI testing in plasma with a 0-3 hour serial-sampling interval.

O

Outcome

Emergency department length of stay (LOS), defined as the time from arrival to ED to either discharge home or hospital admission, measured in minutes.

Main Result

Mean Difference: -67 (95% CI -92.8–-41.3)

Absolute Event Rate: 385% vs 452%

p-value: p=<0.001

Implementing a point-of-care high-sensitivity troponin pathway with a 0-2 hour serial sampling interval significantly reduced emergency department length of stay, particularly for patients requiring serial testing.

Limitations

Early run-in period requiring longer follow-up for durability and seasonality
Susceptible to confounding from background crowding, staffing pressures, and concurrent initiatives
Limited number of daily data points widening uncertainty
Registration time used as a proxy for physical arrival
Chest-pain onset time not available in structured form
Addresses operational outcomes only, lacking safety endpoints
Reflects an early run-in period; longer follow-up is needed for durability and seasonality
Susceptible to confounding from background crowding, staffing pressures and concurrent initiatives
Limited number of daily data points widening uncertainty around estimates
Addresses operational outcomes only; safety endpoints are planned for later

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May shorten ED stays in chest pain pathways; hypothesis-generating and requires randomized confirmation before practice change.

Abstract

BackgroundPoint-of-care (POC) high-sensitivity cardiac troponin I (hs-cTnI) testing can reduce diagnostic turnaround in the emergency department (ED), but real-world operational data remain mixed.MethodsObservational before-after service evaluation at a high-volume UK tertiary ED (Queen Elizabeth University Hospital, Glasgow; ∼200,000 attendances/year). On 12 November 2025 a new chest-pain pathway combined bedside POC hs-cTnI (Abbott i-STAT Alinity) with a reduction in the serial-sampling interval from 0-3 to 0-2 hours, via an immediate hard switch; disposition thresholds were unchanged. The primary outcome was ED length of stay (LOS); interrupted time series (ITS) assessed the temporal association with implementation.ResultsOf 1381 attendances (718 pre- and 663 post-implementation), median LOS fell from 382 to 319 minutes (-63; p < 0.001), and from 510 to 335 minutes among serial-testing patients (-175; Wilcoxon p < 0.001). Four-hour breach fell from 78.8% to 67.3% overall (-11.6 percentage points; 95% confidence interval (CI) -16.2 to -6.9) and from 95.7% to 72.7% in serial testers. ITS showed an immediate level change at go-live (-144 minutes; p < 0.001); estimated capacity released ∼51 bed-hours/day.ConclusionImplementing this POC-based pathway was temporally associated with immediate reductions in ED LOS and 4-hour breach, greatest among serial-testing patients. Benefit is likely greatest where overcrowding and slow laboratory turnaround coexist.

Discussion

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Cite This Study

Ahmad et al. (2026) conducted an observational in Suspected acute coronary syndrome (n=1,381). Point-of-care high-sensitivity cardiac troponin I testing (0-2 hour pathway) vs. Central-laboratory testing (0-3 hour pathway) was evaluated on Emergency department length of stay (LOS) (MD -67 minutes, 95% CI -92.8 to -41.3, p=<0.001). Implementing a point-of-care high-sensitivity troponin pathway reduced mean emergency department length of stay by 67 minutes compared to standard laboratory testing.

synapsesocial.com/papers/6a9d1df228139818eab20a1d https://doi.org/10.1177/00369330261481425

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Real-world impact of implementing a point-of-care high-sensitivity troponin pathway on emergency department flow

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Real-world impact of implementing a point-of-care high-sensitivity troponin pathway on emergency department flow

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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