Emergency Department Clinical and Operational Characteristics After Implementation of High-Sensitivity Troponin Testing Across an Integrated Health System

Multiple health systems have recently transitioned, or are planning to transition, to high-sensitivity troponin assays for evaluation of patients presenting to the emergency department (ED) with possible acute coronary syndrome. We evaluated the impact of high-sensitivity cardiac troponin T (hs-cTnT) adoption on ED operational metrics, diagnostic testing patterns, and outcomes within a large health care system.

Intermountain Health, an integrated health delivery system operating 39 EDs across six states, implemented hs-cTnT at 25 Utah and Idaho hospitals between October 21, 2023, and May 31, 2025. Implementation occurred in a stepped-wedge fashion, with two to three hospitals transitioning from conventional troponin T to hs-cTnT approximately every two months. We conducted a retrospective analysis of all ED encounters in which at least one troponin test was performed during the 19-month implementation period and assessed clinical and operational outcomes.

A total of 350,623 troponin tests were performed among 193,110 unique encounters, with 36.5% of the encounters using the standard troponin assay and 63.5% using the hs-cTnT assay. Mean ED LOS was 10.1 hours for hs-cTnT assay encounters vs. 9.8 hours for standard troponin assay encounters (p < 0.01). Inpatient admission occurred in 29.5% of all encounters, with admission being more common in the hs-cTnT assay group (30.7% vs. 27.4%, p < 0.01). Coronary CT was performed in 1.1% of the hs-cTnT encounters vs. 1.2% in the standard troponin encounters (p < 0.01) while stress testing was performed in 8.4% of hs-cTnT encounters vs. 10.9% standard troponin encounters (p

Across a large integrated health care system, implementation of hs-cTnT testing was associated with a small but statistically significant increase in ED LOS and inpatient admission. However, hs-cTnT adoption corresponded with reduced utilization of coronary CT, cardiac stress testing, and cardiac catheterization. Thirty-day mortality was comparable between hs-cTnT and standard troponin assay groups. These findings may assist health care systems in anticipating operational and clinical implications when transitioning to hs-cTnT testing.