{
  "abstract": "Introduction Chest pain represents a substantive volume of workload for emergency departments. Over-crowding and prolonged length of stay (LoS) are associated with patient harm in the Emergency Department (ED). In suspected acute coronary syndrome (ACS), laboratory high-sensitivity troponin pathways can be operationally constrained by turnaround delays, limiting timely early discharge strategies. We sought to evaluate the early real-world operational impact of implementing point-of-care (PoC) high-sensitivity troponin testing on ED LoS, 4-hour standard performance, and ED capacity.Methods We performed a ‘before–after’ of all adult ED attendances undergoing troponin testing at Queen Elizabeth University Hospital. Outcomes were compared across 3-week periods before and following a ‘hard switch’ on 12 November 2020 from a laboratory 0-3 hour pathway to a bedside PoC 0-2 hour pathway (using the Abbott i-STAT Alinity high sensitivity troponin I assay). Primary outcomes were ED LoS and 4-hour key performance indicator (KPI) breach rates; secondary operational outcomes included estimated ED bed-hours released. LoS comparisons used non-parametric testing. Interrupted time series (ITS) analysis of daily median LoS assessed immediate level changes at go-live and pre and post trends. A conservative sensitivity analysis adjusted post-implementation serial-testing LoS to account for the shorter serial sampling pathway. Cost-minimisation analysis was performed using a patient-level Monte Carlo simulation model from an NHS health-system perspective.Results 1,381 attendances were included (pre n=718; post n=663; mean age 55 yrs, male 51%). Median ED LoS decreased from 382 minutes to 319 minutes (median reduction 63 minutes; p<0.001) ( table 1). The largest improvement occurred in patients requiring serial troponin sampling (table 2): median LoS fell from 510 to 335 minutes (reduction 175 minutes; p<0.005). Overall, 4-hour KPI breach rates improved from 79% to 67% (p<0.001). Interrupted time series demonstrated an immediate reduction in median ED LoS at implementation (reduction of 144 minutes; p<0.001), with a more pronounced effect on patients requiring serial-testing (reduction of 335 minutes following implementation (p<0.001) with no significant change in slope thereafter (figure 1). The observed LoS reduction corresponded to an estimated 40 ED cubicle-hours released per day. PoC high sensitivity troponin cost £103,053 less than lab per 1000 patients presenting to ED with chest pain (£103 per patient tested).Conclusions Implementation of PoC high-sensitivity troponin testing was associated with a statistically robust reduction in ED LoS, improved 4-hour performance, and meaningful ED capacity release. Benefits were greatest in serial-testing patients, consistent with removal of diagnostic delay. Further gains are likely to depend on aligning early clinical review with strengthened ambulatory and low-risk pathways.Abstract 101 Table 1Emergency department length of stay: comparison of pre- and post-implementationGroupNMedian ED LoS (mins)Mean ED LoS (min)4-hour breachAdmittedPre-implementation (lab only)718382 (267-553)452566 (78.8%)285 (39.7%)Post-implementation (PoC)663319 (226-496)385446 (67.3%)226 (34.1%)Abstract 101 Figure 1Interrupted time-series analysis of emergency department length of stay among patients undergoing serial troponin testingAbstract 101 Table 2Emergency department length of stay: comparison of pre- and post-implementation periods by rule out strategyGroupTroponin categoryNMedian ED LoS (min)4-hour breachPre-implementation (lab only)Single test531351 (238–484)387 (72.9%)Serial tests (≥2)187510 (364–752)179 (95.7%)Post-implementation (PoC only)Single test454308 (222–496)294 (64.8%)Serial tests (≥2)209335 (236–497)152 (72.7%)",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, United Kingdom"
      ],
      "name": "Usmaan Razzaq"
    },
    {
      "affiliations": [
        "Department of Clinical Biochemistry, Queen Elizabeth University Hospital, Glasgow, United Kingdom"
      ],
      "name": "Ian Godber"
    },
    {
      "affiliations": [
        "Department of Clinical Biochemistry, Queen Elizabeth University Hospital, Glasgow, United Kingdom"
      ],
      "name": "Angela Burns"
    },
    {
      "affiliations": [
        "Department of Clinical Biochemistry, Queen Elizabeth University Hospital, Glasgow, United Kingdom"
      ],
      "name": "Louise Boughen"
    },
    {
      "affiliations": [
        "West of Scotland Innovation Hub, Queen Elizabeth University Hospital, Glasgow, United Kingdom"
      ],
      "name": "Katriona Brooksbank"
    },
    {
      "affiliations": [
        "Health Economics Policy Lab, University College London, London, United Kingdom"
      ],
      "name": "Rachael Hunter"
    },
    {
      "affiliations": [
        "Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, United Kingdom"
      ],
      "name": "Faheem Ahmad"
    },
    {
      "affiliations": [
        "Emergency Department, Queen Elizabeth University Hospital, Glasgow, United Kingdom"
      ],
      "name": "Andrew Saunders"
    }
  ],
  "title": "101 Real-world impact of point-of-care high-sensitivity troponin on emergency department flow: early results from a major UK tertiary centre",
  "uid": "4eab5ad6-10e7-57fd-b728-57f503b9b73f"
}