Design: Pragmatic stepped-wedge cluster-randomised trial, six sites
Population: 59,980 emergency presentations (44,747 people) with possible acute coronary syndrome
Primary outcome: Emergency department length of stay; safety: 30-day MI or cardiac death
Effect: Length of stay −13% (95% CI 9–16%), −47 minutes; 30-day MI or cardiac death 0.39% vs 0.39%

ICare-FASTER was a pragmatic stepped-wedge cluster-randomised trial across six emergency departments, covering 59,980 presentations with possible myocardial infarction between 2023 and 2025. Both arms used the same accelerated pathway with a single-sample rule-out step. The only difference was whether high-sensitivity troponin came from the central laboratory or a whole-blood point-of-care troponin I assay.

The point-of-care arm shortened length of stay by 13% (95% CI 9–16%), about 47 minutes from a control mean of 376 minutes. Thirty-day myocardial infarction or cardiac death was 0.39% in both arms.

The gain came from results being available when the clinician looked, not from a better assay. That matters wherever laboratory turnaround is the bottleneck, which in many Indian emergency departments it is. The finding applies to a validated high-sensitivity point-of-care assay used inside a structured pathway; older qualitative bedside troponin cards are a different test and were not studied.

Use point-of-care troponin only with a high-sensitivity assay validated for a single-sample rule-out pathway.
Keep the accelerated pathway itself unchanged; the speed came from faster results, not looser criteria.
Do not substitute older qualitative bedside troponin cards, which are not high-sensitivity tests.
Audit length of stay and 30-day events locally if you introduce point-of-care testing.

Why it matters

Laboratory turnaround, not clinical judgement, is often what holds a chest pain patient in the department.

The statistics, in plain English

A stepped-wedge design switches sites to the new method one at a time, so each site acts as its own control and secular trends can be adjusted for. Identical 0.39% event rates in nearly 60,000 presentations make a meaningful safety difference unlikely, though rare events still limit precision.