Single Troponin Accelerated Triage of Chest Pain (STAT-Chest Pain) Study: Assessment of the safety and efficacy of an innovative pathway used to triage patients presenting to the Emergency Department with chest pain.

The single troponin accelerated triage of chest pain study is a prospective cohort study with pre- and post-"STAT pathway" arms. We will implement a clinical pathway for assessment of patients with “Suspected ACS” which will include a “single troponin” arm for patients presenting more than 2 hours after the onset of their symptoms. This will be known as the STAT pathway. This study will aim to capture all patients presenting to Royal Perth Hospital Emergency Department with symptoms suggestive of ACS who are managed as part of the “Suspected ACS” pathway. In the pre- arm, the Suspected ACS pathway will be the pathway recommended by the Australian National Heart Foundation. In the post-intervention arm, the Suspected ACS pathway will be a new pathway as described above - the "STAT pathway". The pre-STAT arm will run for approx 3 months. The post-STAT arm will run for approx 12 months. Initial contact with patients will be made by either an ED clinician, cardiology clinician, research nurse or ED nurse. The “Suspected ACS Pathway” pathway incorporates early detailed clinical assessment in the RPH emergency department by an ED clinician, plus the following: • Initial (0 hours) high sensitivity cardiac troponin I (hs cTnI) measurement • Basic blood tests, including full blood count • Chest X-ray and ECG • Objective chest pain risk score (TIMI or HEART score) • Objective assessment of the risk of pulmonary embolism • Consideration (based on clinical assessment and basic tests) of other important conditions (e.g. aortic dissection, pneumothorax, pneumonia or GI pathology) Given the large numbers of patients expected (~10-15 patients a day) and the impracticalities of delivering an explicit consent across all 24 hours of the day in a busy tertiary emergency department, all participants will be consented as part of an opt-out consent process. After their initial assessment, patients will be managed according to the clinical judgment of the treating doctor, taking into consideration the treatment pathway. All patients recruited in the post-intervention phase who are discharged directly from the ED will receive follow up by the research team in the form of a phone call or sms. If patients have ongoing symptoms or symptoms of concern, they will be invited back for assessment in the outpatient clinic. All high or intermediate risk patients discharged home will be followed up in the outpatient clinic.