Advanced Nurse-Led Referral Versus ED Physician Referral to a Nurse-Led Chest Pain Clinic: Patient Outcomes

2.50
Hdl Handle:
http://hdl.handle.net/10755/621671
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Advanced Nurse-Led Referral Versus ED Physician Referral to a Nurse-Led Chest Pain Clinic: Patient Outcomes
Other Titles:
Promoting Clinical Outcomes in the Cardiac Patient
Author(s):
Ingram, Shirley J.; McKee, Gabrielle; Quirke, Mary B.; Kelly, Niamh
Lead Author STTI Affiliation:
Non-member
Author Details:
Shirley J. Ingram, MsC, RGN, RANP, RNP, NFESC, Professional Experience: 2011 -date Registered Advanced Nurse Practitioner.Chest pain service, Tallaght Hospital. Responsible for starting and running the advanced nurse led chest pain service. Winner of Irish Healthcare Centre Award 2015. Euroheartcare top poster awards winners 2015, 2016 2003-2007 Acting Clinical Nurse Manager 3 Cardiology Dept, Tallaght Hospital.responsible for education, research and clinical service development for the entire cardiology nursing dept which comprises of a 9 bedded CCU, cardiac Catheterisation laboratory, cardiac rehabilitation dept., heart efficiency service, cardiology audit and cardiac procedures. 1994-2007 Clinical Nurse Specialist Cardiac rehabilitation co-ordinator. Developed cardiac rehabilitation programme, nationally recognised. President of Irish Association of Cardiac Rehabilitation 2004-2006. Founding course committee member for MSc in Cardiac Rehabilitation in 2002 with Trinity College, Dublin Author Summary: Shirley is a Registered Advanced Nurse Practitioner (Cardiology) and nurse prescriber of medication and ionising radiation. She is the clinical service lead of a nurse led chest pain service. Shirley qualified in 1989 and has extensive experience in acute cardiac care and cardiac rehabilitation both clinically and in service development. Shirley has published on the role and process of becoming an Advanced Nurse Practitioner.
Abstract:

Background: The role of registered advanced nurse practitioner (RANP) in Ireland is in its infancy compared to the US. The SCAPE study 1 recommended that future research focus on capturing specific clinical outcomes related to advanced nursing practice, however identifying the outcomes of advanced nursing practice is complex. Existing evidence shows similar outcomes for nurse practitioners and physician care in the US 2 and better RANP radiological diagnostic skills in Ireland 3 yet there is a dearth of literature showing better outcomes of RANP led services to usual physician led care.

Internationally chest pain is a common presentation to Emergency Departments (ED), accounting for 5-10% of ED visits annually and a quarter of hospital admissions 4. Over 90% of chest pain presentations are unrelated to acute coronary syndromes (ACS) 5 with less standardised protocols and treatment for this group. An alternative nurse led chest pain service was set up to assess non-ACS chest pain patients presenting to the ED for possible stable coronary artery disease (SCAD). The service consists of two components i) advanced nurse-led consultation in the ED and ii) advanced nurse-led chest pain clinic review < 72 hours after discharge. The aim of the study was to compare patient outcomes post chest pain clinic review by referral type; Advanced nurse-led v ED Physician.

Methods: The study took place in a large tertiary level acute urban teaching hospital in Dublin, Ireland as a one site cross sectional study of patients attending the chest pain clinic over two years. Utilising an accelerated diagnostic protocol (ADP), referrals to the clinic were by the advanced cardiology nurse-led service during consult hours and out-of-hours by the ED physicians. Data was extracted from case notes and analysed using SPSS version 20. Ethical approval was given by the local research ethics committee.

Results: 1041 patients were referred to the nurse-led chest pain clinic, 45% by the nurse-led service. The nurse referred statistically significantly more patients who had; pre-existing vascular disease (24% vs 13%), positive exercise stress test (21% vs 12%), a final diagnosis of stable coronary artery disease (19% vs 11%), were older (56.5 yrs. vs 52.3 yrs.); and less patients with final diagnoses of musculoskeletal (5% vs 13%) and other non-cardiac pain (36% vs 45%) when compared to the ED physician referrals. This reflects appropriate patient selection following nursing-led assessment in the ED with a statistically significant diagnosis of coronary heart disease by the nurse-led service.

Conclusions: This study provides evidence of a successful alternate nurse led model utilising a cardiology advanced nurse practitioner-led service for patients who present to the emergency department with chest pain. It fills a gap in the literature regarding patient outcomes, directly comparing advanced nursing practice with the medical model, evidencing the effectiveness and clinical leadership of RANP led care.

Keywords:
advanced nursing practice; nurse-led chest pain clinic; stable coronary artery disease
Repository Posting Date:
6-Jul-2017
Date of Publication:
6-Jul-2017
Other Identifiers:
INRC17P08
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleAdvanced Nurse-Led Referral Versus ED Physician Referral to a Nurse-Led Chest Pain Clinic: Patient Outcomesen_US
dc.title.alternativePromoting Clinical Outcomes in the Cardiac Patienten
dc.contributor.authorIngram, Shirley J.en
dc.contributor.authorMcKee, Gabrielleen
dc.contributor.authorQuirke, Mary B.en
dc.contributor.authorKelly, Niamhen
dc.contributor.departmentNon-memberen
dc.author.detailsShirley J. Ingram, MsC, RGN, RANP, RNP, NFESC, Professional Experience: 2011 -date Registered Advanced Nurse Practitioner.Chest pain service, Tallaght Hospital. Responsible for starting and running the advanced nurse led chest pain service. Winner of Irish Healthcare Centre Award 2015. Euroheartcare top poster awards winners 2015, 2016 2003-2007 Acting Clinical Nurse Manager 3 Cardiology Dept, Tallaght Hospital.responsible for education, research and clinical service development for the entire cardiology nursing dept which comprises of a 9 bedded CCU, cardiac Catheterisation laboratory, cardiac rehabilitation dept., heart efficiency service, cardiology audit and cardiac procedures. 1994-2007 Clinical Nurse Specialist Cardiac rehabilitation co-ordinator. Developed cardiac rehabilitation programme, nationally recognised. President of Irish Association of Cardiac Rehabilitation 2004-2006. Founding course committee member for MSc in Cardiac Rehabilitation in 2002 with Trinity College, Dublin Author Summary: Shirley is a Registered Advanced Nurse Practitioner (Cardiology) and nurse prescriber of medication and ionising radiation. She is the clinical service lead of a nurse led chest pain service. Shirley qualified in 1989 and has extensive experience in acute cardiac care and cardiac rehabilitation both clinically and in service development. Shirley has published on the role and process of becoming an Advanced Nurse Practitioner.en
dc.identifier.urihttp://hdl.handle.net/10755/621671-
dc.description.abstract<p><strong>Background:</strong><span> The role of registered advanced nurse practitioner (RANP) in Ireland is in its infancy compared to the US. The SCAPE study </span><sup>1</sup><span> recommended that future research focus on capturing specific clinical outcomes related to advanced nursing practice, however identifying the outcomes of advanced nursing practice is complex. Existing evidence shows similar outcomes for nurse practitioners and physician care in the US </span><sup>2</sup><span> and better RANP radiological diagnostic skills in Ireland </span><sup>3</sup><span> yet there is a dearth of literature showing better outcomes of RANP led services to usual physician led care.</span></p> <p>Internationally chest pain is a common presentation to Emergency Departments (ED), accounting for 5-10% of ED visits annually and a quarter of hospital admissions <sup>4</sup>. Over 90% of chest pain presentations are unrelated to acute coronary syndromes (ACS)<sup> 5</sup> with less standardised protocols and treatment for this group. An alternative nurse led chest pain service was set up to assess non-ACS chest pain patients presenting to the ED for possible stable coronary artery disease (SCAD). The service consists of two components i) advanced nurse-led consultation in the ED and ii) advanced nurse-led chest pain clinic review < 72 hours after discharge. The aim of the study was to compare patient outcomes post chest pain clinic review by referral type; Advanced nurse-led v ED Physician.</p> <p><strong>Methods: </strong>The study took place in a large tertiary level acute urban teaching hospital in Dublin, Ireland as a one site cross sectional study of patients attending the chest pain clinic over two years. Utilising an accelerated diagnostic protocol (ADP), referrals to the clinic were by the advanced cardiology nurse-led service during consult hours and out-of-hours by the ED physicians. Data was extracted from case notes and analysed using SPSS version 20. Ethical approval was given by the local research ethics committee.</p> <p><strong>Results:</strong> 1041 patients were referred to the nurse-led chest pain clinic, 45% by the nurse-led service. The nurse referred statistically significantly more patients who had; pre-existing vascular disease (24% vs 13%), positive exercise stress test (21% vs 12%), a final diagnosis of stable coronary artery disease (19% vs 11%), were older (56.5 yrs. vs 52.3 yrs.); and less patients with final diagnoses of musculoskeletal (5% vs 13%) and other non-cardiac pain (36% vs 45%) when compared to the ED physician referrals. This reflects appropriate patient selection following nursing-led assessment in the ED with a statistically significant diagnosis of coronary heart disease by the nurse-led service.</p> <p><strong>Conclusions:</strong> This study provides evidence of a successful alternate nurse led model utilising a cardiology advanced nurse practitioner-led service for patients who present to the emergency department with chest pain. It fills a gap in the literature regarding patient outcomes, directly comparing advanced nursing practice with the medical model, evidencing the effectiveness and clinical leadership of RANP led care.</p>en
dc.subjectadvanced nursing practiceen
dc.subjectnurse-led chest pain clinicen
dc.subjectstable coronary artery diseaseen
dc.date.available2017-07-06T13:43:21Z-
dc.date.issued2017-07-06-
dc.date.accessioned2017-07-06T13:43:21Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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