Implementation of a rapid chest pain protocol in the emergency department: A quality improvement project

Bunch, Azalea Marie; Leasure, A. Renee; Carithers, Cathrin; Burnette, Robert; Berryman, Michael Scott

doi:10.1002/2327-6924.12260

Cited by 2 publications

(5 citation statements)

References 43 publications

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“…Of the articles reporting type of setting where the implementation project/research took place, a majority were undertaken in hospitals ( n = 126) [ 26 , 27 , 30 , 38 , 39 , 41 , 42 , 45 , 49 , 51 – 55 , 60 , 62 – 64 , 67 , 70 – 72 , 77 , 84 , 85 , 88 , 89 , 95 – 98 , 103 , 106 , 107 , 111 , 115 – 118 , 120 – 122 , 128 , 131 , 132 , 136 , 137 , 139 , 143 , 146 , 149 , 151 , 153 – 155 , 157 , 161 , 165 , 167 – 169 , 172 , 173 , 175 , 180 – 182 , 184 , 186 , 190 – 193 , 205 , 207 , 212 , 215 , 221 , 223 , 227 , 230 , 231 ,…”

Section: Resultsmentioning

confidence: 99%

The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature

et al. 2020

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Background: The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. Methods: This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/ countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. Results: The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. Conclusions: In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.

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Section: Resultsmentioning

confidence: 99%

The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature

et al. 2020

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“…The project's goal included successfully developing and implementing a nurse-initiated protocol for patient populations with CP complaints in the ED to decrease LOS and improve flow. A well-organized and evidence-based chest pain protocol in the ED can decrease LOS and avoid adverse outcomes associated with delays in the treatment of ACS or AMI diagnosis imperative for healthier patient outcomes (Bunch et al, 2016). Decreased LOS is a literaturesupported metric for efficiency and vital in ED flow improvement (Douma et al, 2016).…”

Section: Resultsmentioning

confidence: 99%

“…Low acuity patient needs, and nurse-initiated interventions had the highest occurrence of studies that produced a reduced LOS greater than 30% (Miake-Lye et al, 2017). It is crucial to have a wellorganized and evidence-based chest pain protocol in the ED to avoid adverse outcomes related to any delays in the identification and treatment of ACS or MI diagnosis (Bunch et al, 2016).…”

Section: Significance Of the Practice Problemmentioning

confidence: 99%

“…Some organizations currently use rapid assessment pathways or protocols for ACS/CP patients in the ED (Bunch et al, 2016). Protocols provide standardization in practice and reduce unnecessary resources with the final goal of improved care quality and reduced expenses (Bunch et al, 2016). Literature supports utilizing nurse-initiated protocols in the ED to decrease LOS and positively impact costs to the organization (Miake-Lye et al, 2017).…”

Section: Evidence-based Practice Framework and Change Theorymentioning

confidence: 99%

“…NIP implementation demonstrated accelerated diagnostic patient care before a patient-provider interaction (Pierce & Gromley, 2016). Additional evidence shows the benefits of implementing a chest pain protocol in the ED include improved throughput times due to earlier provider evaluations (Bunch et al, 2016).…”

Section: Early Physician Timesmentioning

confidence: 99%

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Nurse-Initiated Protocols for Chest Pain in the Emergency Department

Hodges¹

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Practice Problem: Emergency department crowding inhibits the ability to provide safe patient care to chest pain patients and negatively impact patient outcomes. A Veteran Affairs emergency department has identified a similar concern and implemented a nurse-initiated protocol to decrease the length of stay and improve patient outcomes. PICOT: This evidence-based practice (EBP) project was guided by the following PICOT question: In the emergency department (ED), how does a nurse-initiated protocol (NIP) for chest pain (CP) patients compared to no protocol use influence length of stay (LOS) in the ED over 8 weeks? Evidence: The reviewed literature supported the evidence of effective use of a nurse-initiated protocol in reducing the length of stay in the emergency department. Eleven articles met the inclusion criteria and were used for this literature review. Intervention: The evidence-based nurse-initiated protocol is an intervention to provide objective clinical practice guidelines for chest pain patients resulting in improved earlier diagnostic results and decreased length of stay in the emergency department. Outcome: Post-implementation conclusions revealed no reduction in length of stay after using the protocol but achieved a clinically significant decrease in the time of completion for 12-lead EKGs. Conclusion: Staff education and the implementation of an evidence-based NIP for CP established positive outcomes on reducing EKG times. The results were also clinically significant to validate the implementation of nursing protocols in the ED for decreasing LOS and improving patient outcomes.

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Implementation of a rapid chest pain protocol in the emergency department: A quality improvement project

Cited by 2 publications

References 43 publications

The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature

The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature

Nurse-Initiated Protocols for Chest Pain in the Emergency Department

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