2.50
Hdl Handle:
http://hdl.handle.net/10755/162517
Type:
Presentation
Title:
Increasing Stress in Managing Chest Pain in the ED
Abstract:
Increasing Stress in Managing Chest Pain in the ED
Conference Sponsor:Emergency Nurses Association
Conference Year:2009
Author:Crowe, Jennifer, RN, BSN
P.I. Institution Name:Duke University Medical Center
Title:Clinical Nurse II/Performance Improvement Coordinator
Contact Address:Erwin Rd, Durham, NC, 27703, USA
Co-Authors:Ann White, RN, MSN, CCNS, CEN; Abhinav Chandra, MD, FACEP; Georgianne Mullis, RN, BSN,CEN, FNE
[Annual Conference] Clinical topic: Approximately 4000 patients present annually with chest pain to this Southeastern Level 1 Emergency Department (ED) of a tertiary care medical center. Only about 100 patients demonstrate definitive diagnostic findings for acute myocardial ischemia. For the other patients, the Emergency Medicine physician has the daunting task of determining who is at risk for acute coronary syndrome requiring aggressive diagnostic testing as an inpatient or who could be discharged and followed as an outpatient. A subset of patients cannot be clearly placed in one of these two groups and require exercise cardiac stress testing (stress testing) to ensure safe discharge planning. In 2002, options to complete stress testing for ED patients were referral to an outpatient clinic (Cardiac Diagnostic Unit) which could not provide immediate testing. Same day testing was also difficult to schedule due to the clinic's business hours and overburdened the unit. If the test was scheduled for next day, the dilemma became where was the safest place for the patient to wait. The patient's condition did not warrant the use of major resources like hospital admission but could they go home and risk a cardiac event while waiting for stress testing? This dilemma resulted in the patient remaining in the ED for hours, poor utilization of bed space, long wait times, and dissatisfied patients.

Implementation: ED leadership consulted and collaborated with the Cardiac Diagnostic Unit to develop skills and competencies for the emergency nurse to provide stress testing in the ED. A model of a clinical expert in stress testing who then trains and evaluates other emergency nurses in the role was adopted. The emergency nurse selected for this advanced clinical role received didactic content, and was required to successfully complete a 12-lead ECG course. Eight proctored stress tests with 12-lead ECG over-read were selected as the benchmark for competency before the emergency nurse could perform stress testing independently.

Outcomes: Currently six emergency nurses function in this role, supported by the Cardiac Diagnostic Unit and Emergency Medicine providers, performing 600 stress tests annually. Outcome data demonstrate appropriate patient selection for admission and discharge as only 10% of patients who receive a stress test in the ED require admission for acute cardiac ischemia. No untoward events have occurred related to the stress testing and the emergency nurse is correctly terminating a test based on patient monitoring.

Recommendations: Providing exercise cardiac stress testing in the ED is safe, positively affects patient satisfaction, impacts cost by reducing unnecessary hospital admissions, and decreases the burden on the outpatient diagnostic unit.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleIncreasing Stress in Managing Chest Pain in the EDen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162517-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Increasing Stress in Managing Chest Pain in the ED</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Crowe, Jennifer, RN, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Duke University Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Nurse II/Performance Improvement Coordinator</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Erwin Rd, Durham, NC, 27703, USA</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Ann White, RN, MSN, CCNS, CEN; Abhinav Chandra, MD, FACEP; Georgianne Mullis, RN, BSN,CEN, FNE</td></tr><tr><td colspan="2" class="item-abstract">[Annual Conference] Clinical topic: Approximately 4000 patients present annually with chest pain to this Southeastern Level 1 Emergency Department (ED) of a tertiary care medical center. Only about 100 patients demonstrate definitive diagnostic findings for acute myocardial ischemia. For the other patients, the Emergency Medicine physician has the daunting task of determining who is at risk for acute coronary syndrome requiring aggressive diagnostic testing as an inpatient or who could be discharged and followed as an outpatient. A subset of patients cannot be clearly placed in one of these two groups and require exercise cardiac stress testing (stress testing) to ensure safe discharge planning. In 2002, options to complete stress testing for ED patients were referral to an outpatient clinic (Cardiac Diagnostic Unit) which could not provide immediate testing. Same day testing was also difficult to schedule due to the clinic's business hours and overburdened the unit. If the test was scheduled for next day, the dilemma became where was the safest place for the patient to wait. The patient's condition did not warrant the use of major resources like hospital admission but could they go home and risk a cardiac event while waiting for stress testing? This dilemma resulted in the patient remaining in the ED for hours, poor utilization of bed space, long wait times, and dissatisfied patients. <br/><br/>Implementation: ED leadership consulted and collaborated with the Cardiac Diagnostic Unit to develop skills and competencies for the emergency nurse to provide stress testing in the ED. A model of a clinical expert in stress testing who then trains and evaluates other emergency nurses in the role was adopted. The emergency nurse selected for this advanced clinical role received didactic content, and was required to successfully complete a 12-lead ECG course. Eight proctored stress tests with 12-lead ECG over-read were selected as the benchmark for competency before the emergency nurse could perform stress testing independently. <br/><br/>Outcomes: Currently six emergency nurses function in this role, supported by the Cardiac Diagnostic Unit and Emergency Medicine providers, performing 600 stress tests annually. Outcome data demonstrate appropriate patient selection for admission and discharge as only 10% of patients who receive a stress test in the ED require admission for acute cardiac ischemia. No untoward events have occurred related to the stress testing and the emergency nurse is correctly terminating a test based on patient monitoring. <br/><br/>Recommendations: Providing exercise cardiac stress testing in the ED is safe, positively affects patient satisfaction, impacts cost by reducing unnecessary hospital admissions, and decreases the burden on the outpatient diagnostic unit.</td></tr></table>en_GB
dc.date.available2011-10-27T10:29:32Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:29:32Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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