2.50
Hdl Handle:
http://hdl.handle.net/10755/306594
Category:
Abstract
Type:
Poster
Title:
Reducing the Length of Stay for Chest Pain Patients
Author(s):
Streets, Kara; Bickers, Sharon M.
Lead Author STTI Affiliation:
Non-member
Author Details:
Kara Streets, MS, BSN, RN, CEN, NE-BC, kstreets@christianacare.org; Sharon M. Bickers, MSN, RN, CEN
Abstract:

Evidence-based Practice Abstract

Purpose: Patients with a chief complaint of chest pain account for more than 6 million annual emergency department (ED) visits nationally. This population represents approximately 5% of all ED visits and accounts for an estimated 25% of all emergency medical admissions. Low to moderate risk chest pain patients requiring admission are typically placed in an observation unit such as a Clinical Decision Unit (CDU). Currently, 32 hours elapse between time of triage to hospital discharge for observation patients.

Design: A multidisciplinary team convened to develop a pilot process that would decrease the ED length of stay (LOS), boarding hours and overall length of stay for low to intermediate risk chest pain patients requiring admission. A goal of 18 hours was identified.

Setting: The institution is a designated level 1 trauma center, certified heart center and teaching facility located in a suburban setting on the east coast. Annual ED census is approximately 118,000. Pilot patients will be cohorted in the CDU; a step-down level, 23 bed unit adjacent to the emergency department with 20 beds dedicated to the care of observation patients. Nurse to patient ratio is 1:5. The average monthly census is 500+ patients which includes approximately 50% with a diagnosis of chest pain.

Participants: Key stakeholders included ED physicians, CDU staff and hospital based cardiology and hospitalist group physicians. Pilot patients were selected by the ED physician utilizing the following criteria: > 18 years of age, chief complaint of chest pain without dynamic ST wave changes or EKG indications of acute myocardial infarction. In addition, an admission diagnosis to rule out myocardial infarction and an assigned cardiologist within the hospital based group or, if no assigned cardiologist, a primary care physician that utilizes the hospital based hospitalist group were also requirements. Lastly, the patient’s clinical condition must fall within the accepted CDU admission criteria.

Methods: After emergency physician evaluation and pilot candidate identification, the patient is posted to the CDU, the appropriate physician group is notified of pending admission and the CDU nurse practitioner receives report. The patient is assigned to the next available CDU bed and is transferred. Attending physician evaluation and subsequent placement of orders then occurs in the CDU, not the ED.

Results: Overall, time from evaluation by the ED attending physician to disposition was reduced by 50%; ED LOS was reduced by 33%; time from ED arrival to disposition was reduced by 30%; time from ED arrival to hospital discharge decreased by 29%; time from ED disposition to CDU arrival was reduced by 15% and overall CDU LOS was diminished by 6%.

Implications: This pilot expedited the throughput of low risk chest pain patients and resulted in significant timeframe reductions in many key areas. As physician awareness, utilization and comfort in utilizing such a protocol becomes more commonplace, overall productivity, safety and both patient and staff satisfaction will increase for the ED, CDU and hospital based physician groups.

Keywords:
Reducing LOS for chest pain patients
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Nashville, Tennessee, USA
Description:
2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleReducing the Length of Stay for Chest Pain Patientsen_GB
dc.contributor.authorStreets, Karaen_GB
dc.contributor.authorBickers, Sharon M.en_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsKara Streets, MS, BSN, RN, CEN, NE-BC, kstreets@christianacare.org; Sharon M. Bickers, MSN, RN, CENen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306594-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: Patients with a chief complaint of chest pain account for more than 6 million annual emergency department (ED) visits nationally. This population represents approximately 5% of all ED visits and accounts for an estimated 25% of all emergency medical admissions. Low to moderate risk chest pain patients requiring admission are typically placed in an observation unit such as a Clinical Decision Unit (CDU). Currently, 32 hours elapse between time of triage to hospital discharge for observation patients.</p><p>Design: A multidisciplinary team convened to develop a pilot process that would decrease the ED length of stay (LOS), boarding hours and overall length of stay for low to intermediate risk chest pain patients requiring admission. A goal of 18 hours was identified.</p><p>Setting: The institution is a designated level 1 trauma center, certified heart center and teaching facility located in a suburban setting on the east coast. Annual ED census is approximately 118,000. Pilot patients will be cohorted in the CDU; a step-down level, 23 bed unit adjacent to the emergency department with 20 beds dedicated to the care of observation patients. Nurse to patient ratio is 1:5. The average monthly census is 500+ patients which includes approximately 50% with a diagnosis of chest pain.</p><p>Participants: Key stakeholders included ED physicians, CDU staff and hospital based cardiology and hospitalist group physicians. Pilot patients were selected by the ED physician utilizing the following criteria: > 18 years of age, chief complaint of chest pain without dynamic ST wave changes or EKG indications of acute myocardial infarction. In addition, an admission diagnosis to rule out myocardial infarction and an assigned cardiologist within the hospital based group or, if no assigned cardiologist, a primary care physician that utilizes the hospital based hospitalist group were also requirements. Lastly, the patient’s clinical condition must fall within the accepted CDU admission criteria.</p><p>Methods: After emergency physician evaluation and pilot candidate identification, the patient is posted to the CDU, the appropriate physician group is notified of pending admission and the CDU nurse practitioner receives report. The patient is assigned to the next available CDU bed and is transferred. Attending physician evaluation and subsequent placement of orders then occurs in the CDU, not the ED.</p><p>Results: Overall, time from evaluation by the ED attending physician to disposition was reduced by 50%; ED LOS was reduced by 33%; time from ED arrival to disposition was reduced by 30%; time from ED arrival to hospital discharge decreased by 29%; time from ED disposition to CDU arrival was reduced by 15% and overall CDU LOS was diminished by 6%. </p><p>Implications: This pilot expedited the throughput of low risk chest pain patients and resulted in significant timeframe reductions in many key areas. As physician awareness, utilization and comfort in utilizing such a protocol becomes more commonplace, overall productivity, safety and both patient and staff satisfaction will increase for the ED, CDU and hospital based physician groups.</p>en_GB
dc.subjectReducing LOS for chest pain patientsen_GB
dc.date.available2013-12-09T17:00:22Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:22Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationNashville, Tennessee, USAen_GB
dc.description2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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