Determining chest pain patients’ suitability for transfer to a general ward following admission to a cardiac care unit

Abstract

The objective of this study was to assess the performance of a consensus-derived decision algorithm in determining chest pain patients' suitability for early transfer to a lower dependency ward by predicting complications. The sample comprised 516 patients with chest pain presumed to be cardiac in origin, admitted to a cardiac care unit (CCU) in northern England from the community or from the accident and emergency department. A decision algorithm was designed following a review of the literature and amended to take into account a clinical consensus of consultant physicians. Patients were assessed on admission by CCU nurses using the algorithm, and 'triage' decisions recorded (keep on CCU or suitable for early transfer to a general ward). Admission ECGs (electrocardiographs) and baseline clinical data were recorded independently by a researcher 'blinded' to actual clinical course, and applied to the algorithm using statistical software. On discharge or death, patients' case notes were retrieved and the hospital course examined for death or severe complications. Performance of the algorithm and CCU nurses were compared for sensitivity, specificity, positive predictive value and negative predictive value. The main outcome measures were death or severe complications occurring during hospitalization, and during the first 2 days following CCU admission. While sensitivity of both the algorithm (0.98) and CCU nurses (0.95) was high, specificity was low in both groups (0.11 and 0.21, respectively), making it unlikely that the algorithm would prove useful in clinical practice. Further studies are required to develop the optimal triage tool for the assessment of patients with acute chest pain.

The Role of Nurses in a Chest Pain Unit

“…The major source of discordance or misclassification was that nurses tended to overestimate disease severity in this study. However, this is the opposite of findings from a study by Quinn et al [60]. In their study CCU nurses were more likely to identify a chest pain patient as suitable for admission to a general ward, compared with a physician-derived algorithm.…”

What is the Role of the Coronary Care Nurse? A Review of the Literature

“…In addition a study by Quinn et al [18] also found that coronary care nurses in a hospital in the North of England were skilled in the assessment of their patient's cardiac conditions and were able to distinguish between those that require differing levels of nursing care. This single centre study was developed to investigate the performance of an algorithm that may be used to identify patients suitable for early transfer from the coronary care unit.…”

Measuring the quality of judgement and decision‐making in nursing

“…Three studies have examined the appropriateness of nurse triage decision‐making (Leprohon & Patel 1995, Considine et al. 2000, Quinn et al. 2000).…”

“…As in the research into judgement, the study by Quinn et al. (2000) has a strength in that it compares nurses’ decisions to actual patient outcomes.…”

“…Three studies have examined the appropriateness of nurse triage decision-making (Leprohon & Patel 1995, Considine et al 2000, Quinn et al 2000. Considine et al (2000) used 10 scenarios based on patient cases to investigate the appropriateness of triage decisions in 31 nurses.…”