title: The impact of high-sensitivity troponin implementation on hospital operations and patient outcomes in 3 tertiary care centers.
abstract: OBJECTIVE
  High-sensitivity troponin T (hs-TnT) assays detect myocardial injury sooner, possibly improving throughput times for emergency department (ED) assessment of suspected acute myocardial infarction (AMI). This study evaluates the influence of hs-TnT implementation on ED length of stay (LOS), consultations and admissions, as well as ED revisits with cardiology admissions for patients undergoing testing for suspected AMI.
  
  
  METHODS
  This control pre-post design analysis included patients evaluated using hs-TnT or conventional troponin T. Data were collected from 3 ED databases for patients who had a troponin assay for suspected AMI for the periods February 12, 2011-April 22, 2011 (Ctrl); November 20, 2011-January 28, 2012 (Pre); and February 12, 2012-April 21, 2012 (Post). The primary outcome was ED LOS; secondary outcomes included the proportions of patients who received ED cardiology consultations, patients who were admitted to hospital, and discharged patients who revisited the ED within 30 days.
  
  
  RESULTS
  Data were analyzed from 6650 (Ctrl), 6866 (Pre), and 5754 (Post) patients. Median ED LOS decreased following hs-TnT implementation (6.60 hours in Ctrl and Pre vs 6.10 hours in Post, P < .001). There was no change in cardiology consultations or admissions following hs-TnT implementation. Fewer ED revisits occurred within 30 days in Post (16.0% Ctrl, 16.5% Pre vs 14.9% Post; P < .01). These results were preserved after adjusting for age and Canadian Triage Acuity Score.
  
  
  CONCLUSIONS
  This hs-TnT implementation strategy, using an equivalent cutoff for the conventional troponin T and hs-TnT assays, decreased ED LOS for patients with suspected AMI and did not increase cardiology resource utilization or ED revisits.
authors.affiliation: University of Calgary, Foothills Campus, 3330 Hospital Dr NW, Calgary, AB, Canada T2N 4N1; Alberta Health Services, Foothills Medical Center 1403-29 St NW, Calgary, AB, Canada T2N 2T9.
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: Crowder
authors.affiliation: University of Calgary, Foothills Campus, 3330 Hospital Dr NW, Calgary, AB, Canada T2N 4N1.
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Jones
authors.affiliation: University of Calgary, Foothills Campus, 3330 Hospital Dr NW, Calgary, AB, Canada T2N 4N1; Alberta Health Services, Foothills Medical Center 1403-29 St NW, Calgary, AB, Canada T2N 2T9.
authors.forename: Eddy S
authors.initials: ES
authors.lastname: Lang
authors.affiliation: University of Calgary, Foothills Campus, 3330 Hospital Dr NW, Calgary, AB, Canada T2N 4N1; Alberta Health Services, Foothills Medical Center 1403-29 St NW, Calgary, AB, Canada T2N 2T9.
authors.forename: Dongmei M
authors.initials: DM
authors.lastname: Wang
authors.affiliation: University of Calgary, Foothills Campus, 3330 Hospital Dr NW, Calgary, AB, Canada T2N 4N1; Alberta Health Services, Foothills Medical Center 1403-29 St NW, Calgary, AB, Canada T2N 2T9.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Clark
authors.affiliation: University of Calgary, Foothills Campus, 3330 Hospital Dr NW, Calgary, AB, Canada T2N 4N1; Alberta Health Services, Foothills Medical Center 1403-29 St NW, Calgary, AB, Canada T2N 2T9.
authors.forename: Grant D
authors.initials: GD
authors.lastname: Innes
authors.affiliation: University of Calgary, Foothills Campus, 3330 Hospital Dr NW, Calgary, AB, Canada T2N 4N1; Alberta Health Services, Foothills Medical Center 1403-29 St NW, Calgary, AB, Canada T2N 2T9.
authors.forename: James D
authors.initials: JD
authors.lastname: McMeekin
authors.affiliation: Alberta Health Services, Foothills Medical Center 1403-29 St NW, Calgary, AB, Canada T2N 2T9; University of Alberta, 8440 112 St NW, Edmonton, AB, Canada T6G 2B7.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Graham
authors.affiliation: University of Calgary, Foothills Campus, 3330 Hospital Dr NW, Calgary, AB, Canada T2N 4N1; Alberta Health Services, Foothills Medical Center 1403-29 St NW, Calgary, AB, Canada T2N 2T9. Electronic address: amcrae@ucalgary.ca.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: McRae
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta; D015415:Biomarkers / Q000097:blood; D065187:Controlled Before-After Studies; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis* / Q000628:therapy; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D062606:Tertiary Care Centers; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T