• Rylee S Doucette, Emily Dibble, Nonie S Arora, David M Somand, Steven Kronick, Eve Kerr, Scott Flanders, and Geoffrey D Barnes.
• School of Public Health, University of Michigan, Ann Arbor; Michigan Program on Value Enhancement, Michigan Medicine, Ann Arbor, Mich.
• Am. J. Med. 2020 Sep 1; 133 (9): e483-e494.

PurposeA newly approved, high-sensitivity troponin T (hsTnT) assay may offer opportunities to more rapidly assess for acute coronary syndrome and identify lower thresholds of myocardial injury. As more emergency departments begin to use the hsTnT assay, anticipating barriers to hsTnT implementation success are critical to realizing potential benefits in rapid, accurate patient assessment.MethodsAt a tertiary health system emergency department, hsTnT was implemented along with a diagnostic algorithm and a decision tree to aid in utilization. Qualitative interviews with 18 physicians and advance practice providers were conducted 2 months' postimplementation and again 4 to 6 months postimplementation to capture clinician perceptions to hsTnT implementation efforts. Deductive coding was performed using implementation science determinants frameworks to identify emerging themes related to this topic.ResultsFour themes emerged from the interviews: 1) the need for additional clinician education, 2) challenges with care handoffs, 3) lack of buy-in from the hospital community, and 4) key successes.ConclusionInterviews demonstrated that implementation of hsTnT was associated with several implementation barriers from the perspective of emergency department clinicians. Future implementation efforts should focus on diverse and sustained staff educational efforts, models that address challenges with care handoffs between emergency department clinicians and inpatient clinicians, and operational teams that include inpatient clinicians to facilitate buy-in.Copyright © 2020 Elsevier Inc. All rights reserved.

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