2.50
Hdl Handle:
http://hdl.handle.net/10755/162540
Type:
Presentation
Title:
Opening a Chest Pain Unit in the Emergency Department, Outcomes
Abstract:
Opening a Chest Pain Unit in the Emergency Department, Outcomes
Conference Sponsor:Emergency Nurses Association
Conference Year:2009
Author:Raife, Kathleen, RN, MS, ANP-C
P.I. Institution Name:Banner Baywood Medical Center
Title:Nurse Practitioner
Contact Address:6644 E. Baywood, Mesa, AZ, 85206, USA
Contact Telephone:480-321-4211
[Annual Conference] Clinical Topic: In 2002, Emergency Department (ED) overcrowding and limited telemetry beds forced our administrative team to look for more efficient ways to evaluate chest pain(CP) patients(pts). Our ED saw a large percent of elderly patients and CP was a very common diagnosis. Our ED evaluated the patients and made the disposition decision: admit to the medical center or transfer to a facility with cath lab and cardiac surgery capabilities. In 2002, patients with CP but without ST segment elevation were admitted to telemetry for 2-3 days where serial enzymes (q8x3), and diagnostic tests were performed to identify if infarction had occurred and the need for further invasive procedures.

Implementation: That summer, the leadership team attended a presentation by Sandra Sieck, RN describing the benefits of an out-patient Chest Pain Observation unit (CPU). Recent changes in reimbursement had created a more favorable environment for the out-patient management of CP patients. A decision was made to open a 7 bed CPU in the ED. A multi-disciplinary team was formed with the goal of opening the CPU in March 2003.
Order sets were modeled after the AHA/ACC guidelines for CP. Criteria for OBS included a diagnosis of CP. Two ECGs and two sets of cardiac enzymes were to be performed. Patients were to be admitted or discharged within 48 hrs with a goal of less than 24 hrs. The unit also would have the capability to perform out-pt stress tests.

Outcomes: This helped to free up telemetry beds for pts with more complex diagnoses. Physician confidence grew and in the fall of 2003, acute cardiac pts were also evaluated in the CPU and managed by an ED physician and/or nurse practitioner. This included pts such as acute MIs. The ED and CPU staff focused on improving door to ECG times and were successful in lower the average ECG time from greater than 20 minutes to less than 10 minutes by Dec 2003. It has held at 10.4 minutes for the last 4 years. This set the framework for a cardiac center of excellence in the ED.
With the support of updated guidelines, a twelve hour rule-out model was implemented. This included repeat cardiac enzymes and ECGs at 6 hours of OBS. Our CPU monthly census has been 328 pts for the last 5 years and is well accepted by the cardiologists in our community.

Recommendations: This type of unit may assist with more appropriate placement of telemetry patients and decreasing length of stay if the hospital has a large number of chest pain patients.
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.titleOpening a Chest Pain Unit in the Emergency Department, Outcomesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162540-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Opening a Chest Pain Unit in the Emergency Department, Outcomes</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">Raife, Kathleen, RN, MS, ANP-C</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Banner Baywood Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Nurse Practitioner</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">6644 E. Baywood, Mesa, AZ, 85206, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">480-321-4211</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">katie.raife@bannerhealth.com</td></tr><tr><td colspan="2" class="item-abstract">[Annual Conference] Clinical Topic: In 2002, Emergency Department (ED) overcrowding and limited telemetry beds forced our administrative team to look for more efficient ways to evaluate chest pain(CP) patients(pts). Our ED saw a large percent of elderly patients and CP was a very common diagnosis. Our ED evaluated the patients and made the disposition decision: admit to the medical center or transfer to a facility with cath lab and cardiac surgery capabilities. In 2002, patients with CP but without ST segment elevation were admitted to telemetry for 2-3 days where serial enzymes (q8x3), and diagnostic tests were performed to identify if infarction had occurred and the need for further invasive procedures. <br/><br/>Implementation: That summer, the leadership team attended a presentation by Sandra Sieck, RN describing the benefits of an out-patient Chest Pain Observation unit (CPU). Recent changes in reimbursement had created a more favorable environment for the out-patient management of CP patients. A decision was made to open a 7 bed CPU in the ED. A multi-disciplinary team was formed with the goal of opening the CPU in March 2003.<br/> Order sets were modeled after the AHA/ACC guidelines for CP. Criteria for OBS included a diagnosis of CP. Two ECGs and two sets of cardiac enzymes were to be performed. Patients were to be admitted or discharged within 48 hrs with a goal of less than 24 hrs. The unit also would have the capability to perform out-pt stress tests. <br/><br/>Outcomes: This helped to free up telemetry beds for pts with more complex diagnoses. Physician confidence grew and in the fall of 2003, acute cardiac pts were also evaluated in the CPU and managed by an ED physician and/or nurse practitioner. This included pts such as acute MIs. The ED and CPU staff focused on improving door to ECG times and were successful in lower the average ECG time from greater than 20 minutes to less than 10 minutes by Dec 2003. It has held at 10.4 minutes for the last 4 years. This set the framework for a cardiac center of excellence in the ED. <br/> With the support of updated guidelines, a twelve hour rule-out model was implemented. This included repeat cardiac enzymes and ECGs at 6 hours of OBS. Our CPU monthly census has been 328 pts for the last 5 years and is well accepted by the cardiologists in our community. <br/><br/>Recommendations: This type of unit may assist with more appropriate placement of telemetry patients and decreasing length of stay if the hospital has a large number of chest pain patients.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:29:55Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:29:55Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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