Development and Implementation of an Emergency Department Based Chest Pain Protocol

2.50
Hdl Handle:
http://hdl.handle.net/10755/162799
Type:
Presentation
Title:
Development and Implementation of an Emergency Department Based Chest Pain Protocol
Abstract:
Development and Implementation of an Emergency Department Based Chest Pain Protocol
Conference Sponsor:Emergency Nurses Association
Conference Year:1997
Author:Casey, Kathy H., RN, MN, ANPC
Contact Address:, USA
Clinical Topic: This project was undertaken to (1) Assess the management of patients with chest pain in our ED; (2) Set up a multidisciplinary team to assess the management process and develop a chest pain protocol to improve clinical performance; (3) Implement the chest pain protocol; and (4) Reevaluate outcomes.

Process of Implementation: Planning and implementation of the project was completed over the course of 3 years and included (1) Obtaining baseline data (including arrival time to the ED) from chest pain onset, time to triage, physician examination, drug therapy (if appropriate), test performance, laboratory studies, and transfer to hospital bed; (2) Evaluating results, reviewing the literature, and determining areas for improvement; (3) Developing a multidisciplinary team approach to review data and system processes to identify strategies for action, and (4) Reevaluating outcomes.

Outcomes: Baseline data (1993) revealed the following average times to intervention: triage, 3 minutes; examination by an ED physician, 27 minutes; examination by a cardiologist, 1 hour 45 minutes; oxygen/IV initiated, 27 minutes; electrocardiogram (ECG) performed (not interpreted), 20 minutes; laboratory studies, 54 minutes; aspirin given, 2 hours; thrombolytic therapy (if appropriate), 87 minutes; and transfer to hospital room, 2 hours 37 minutes. Documentation was also identified as a large problem. Implementation of the chest pain order sheet and clinical care pathways demonstrated improvement in all parameters for time to treatment and documentation, for example: 80% of patients presenting to the ED with chest pain have an ECG done within 15 minutes of arrival; aspirin is administered to 90% of patients within 15 minutes of arrival, and 80% of patients receive thrombolytic therapy within 1 hour of arrival (mean time 66 minutes).

Recommendations for Clinical Practice: Efforts to improve the management of patients with chest pain due to acute pain protocol and clinical care pathways are recommended. All disciplines in an institution must participate in developing the protocol and clinical care pathways to ensure their success. [Clinical Poster Presentation]
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.titleDevelopment and Implementation of an Emergency Department Based Chest Pain Protocolen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162799-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Development and Implementation of an Emergency Department Based Chest Pain Protocol</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">1997</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Casey, Kathy H., RN, MN, ANPC</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">res@ena.org</td></tr><tr><td colspan="2" class="item-abstract">Clinical Topic: This project was undertaken to (1) Assess the management of patients with chest pain in our ED; (2) Set up a multidisciplinary team to assess the management process and develop a chest pain protocol to improve clinical performance; (3) Implement the chest pain protocol; and (4) Reevaluate outcomes.<br/><br/>Process of Implementation: Planning and implementation of the project was completed over the course of 3 years and included (1) Obtaining baseline data (including arrival time to the ED) from chest pain onset, time to triage, physician examination, drug therapy (if appropriate), test performance, laboratory studies, and transfer to hospital bed; (2) Evaluating results, reviewing the literature, and determining areas for improvement; (3) Developing a multidisciplinary team approach to review data and system processes to identify strategies for action, and (4) Reevaluating outcomes.<br/><br/>Outcomes: Baseline data (1993) revealed the following average times to intervention: triage, 3 minutes; examination by an ED physician, 27 minutes; examination by a cardiologist, 1 hour 45 minutes; oxygen/IV initiated, 27 minutes; electrocardiogram (ECG) performed (not interpreted), 20 minutes; laboratory studies, 54 minutes; aspirin given, 2 hours; thrombolytic therapy (if appropriate), 87 minutes; and transfer to hospital room, 2 hours 37 minutes. Documentation was also identified as a large problem. Implementation of the chest pain order sheet and clinical care pathways demonstrated improvement in all parameters for time to treatment and documentation, for example: 80% of patients presenting to the ED with chest pain have an ECG done within 15 minutes of arrival; aspirin is administered to 90% of patients within 15 minutes of arrival, and 80% of patients receive thrombolytic therapy within 1 hour of arrival (mean time 66 minutes).<br/><br/>Recommendations for Clinical Practice: Efforts to improve the management of patients with chest pain due to acute pain protocol and clinical care pathways are recommended. All disciplines in an institution must participate in developing the protocol and clinical care pathways to ensure their success. [Clinical Poster Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:34:22Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:34:22Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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