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

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.