The impact of an accelerated diagnostic protocol using conventional troponin I for patients with cardiac chest pain in the emergency department.

Background This study strove to assess the impact of the implementation of an accelerated diagnostic protocol (ADP) using shortened serial testing intervals and a conventional troponin I (c-TnI) on emergency department (ED) length of stay (LOS). Methods This is a retrospective cohort study of adults (≥ 18 yr) presenting to a Canadian ED with a primary complaint of cardiac chest pain between January 14, 2017, and January 15, 2019. For non-high-risk patients, the troponin delta timing decreased from 6 hours to 3 hours and a different c-TnI cut-point was implemented on January 15, 2018. The primary outcome was ED LOS. Secondary outcomes included disposition status, consultation proportions, and Major Adverse Cardiac Events (MACE) within 30 days. Results There was a total of 3133 patient interactions included. Although the overall decrease in median ED LOS was not significant (p=0.074), there was a significant reduction of in ED LOS (-33 minutes; 95% CI: -53.6 to -12.4 minutes) among patients who were discharged in the post-ADP group. Consultations were unchanged between groups (36.1% before vs. 33.8% after; p=0.17). The MACE outcomes were unchanged across cohorts (15.9% vs. 15.3%; p=0.62). Conclusions The implementation of an ADP, with a conventional troponin I, for cardiac chest pain in a Canadian ED was not associated with a significant reduction of LOS for all patients; however, there was a significant reduction for patients who were discharged, and the strategy appears safe.