Non-ST elevation acute coronary syndromes (NSTE-ACS) have significant morbidity and mortality rates despite the progress made in diagnosis and management and represent a significant public health burden in the United States. Lengthy diagnostic algorithms contribute to emergency department over-crowding, increased health care costs, and adverse patient outcomes. A troponin assay instituted earlier in the diagnostic pathway of patients with chest pain suspected of NSTE-ACS will reduce time to definitive diagnosis and medical intervention. This will improve patient outcomes, decrease emergency department crowding through improved ED workflow, and reduce the economic burden. The Star Model of Knowledge Transformation was used to guide an understanding of the cycles, nature, and characteristics of knowledge of NSTE-ACS, organize previous and current concepts of improving care, and provided the framework to guide design, implementation, evaluation and sustainability. The Prehospital Troponin Testing Protocol (PHTTP) instituted a point-of-care troponin assay in the ambulances of the Plainview Fire-EMS department and used this value in an accelerated diagnostic pathway in the Covenant Plainview Emergency Department. The PHTTP reduced the time to first troponin from 79 minutes (1.32 hours) to 22 minutes (0.37 hours) and time to disposition of patients from 191.00 minutes (3.18 hour) to 150.04 minutes (2.50 hours). Time to first troponin was reduced by 47.00 minutes (0.78 hours) and length of stay was reduced by 40.96 minutes (0.67 hours). The prehospital scene time was increased by 1 minute which was not statistically significant.

Date of publication

Spring 3-26-2019

Document Type

DNP Scholarly Project



Persistent identifier


Committee members

Marcie Lusk, DNP, APRN, FNP-BC, Beau L. McCrory, MD, Sandra Petersen, DNP, APRN, FNP/GNP-BC, PMHNP, Barbara Hass, PhD, RN, Yong Tai Wang, PhD, FACSM


Doctor of Nursing Practice