The impact of prehospital blood sampling on the emergency department process of patients with chest pain

2022 ◽  
Author(s):  
M.Christien van der Linden
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Blood Sampling ◽  
The Impact

scholarly journals COVID-19 Pandemic Once Again Exposes the Weakest Link in Laboratory Services: Specimen Delivery

2020 ◽  
Vol 51 (6) ◽  
pp. e83-e86 ◽  
Author(s):  
Ivana Lapić ◽  
Sven Komljenović ◽  
Josip Knežević ◽  
Dunja Rogić
Keyword(s):  
Emergency Department ◽  
Turnaround Time ◽  
Blood Sampling ◽  
Central Laboratory ◽  
Weakest Link ◽  
Laboratory Services ◽  
Significant Difference ◽  
The Impact ◽  
Usual Laboratory

Abstract Objective Reorganization of the emergency department (ED) during the COVID-19 pandemic implied closure of the ED-dedicated laboratory and manual transport of all specimens to the dislocated central laboratory. The impact of such reorganization on laboratory turnaround time (TAT) was examined. Methods The TAT from blood sampling to specimen reception (TAT1), from specimen reception to test reporting (TAT2), and from sampling to test reporting (TAT3) were compared between the pandemic peak month in 2020 and the same month in 2019. We evaluated whether TAT2 fulfills the recommended 60-minute criteria. Results A statistically significant difference was observed for all comparisons (P <.001), with TAT1 prominently contributing to TAT3 prolongation (from 48 minutes to 108 minutes) and exceeding the recommended 60-minute criteria. The TAT2 was extended from 33 minutes to 49 minutes. Conclusion An ED reorganization compromised the usual laboratory services for patients in the ED, with manual specimen delivery being the main cause for TAT prolongation.

scholarly journals Impact of the COVID-19 Pandemic on the Loading and Quality of an Emergency Department in Taiwan: Enlightenment from a Low-Risk Country in a Public Health Crisis

2021 ◽  
Vol 10 (6) ◽  
pp. 1150
Author(s):  
Jamie Yu-Hsuan Chen ◽  
Feng-Yee Chang ◽  
Chin-Sheng Lin ◽  
Chih-Hung Wang ◽  
Shih-Hung Tsai ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Chest Pain ◽  
Low Risk ◽  
Health Crisis ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Patient Prognosis ◽  
The Impact

The impact of the coronavirus disease 2019 (COVID-19) pandemic on health-care quality in the emergency department (ED) in countries with a low risk is unclear. This study aimed to explore the effects of the COVID-19 pandemic on ED loading, quality of care, and patient prognosis. Data were retrospectively collected from 1 January 2018 to 30 September 2020 at the ED of Tri-service general hospital. Analyses included day-based ED loading, quality of care, and patient prognosis. Data on triage assessment, physiological states, disease history, and results of laboratory tests were collected and analyzed. The number of daily visits significantly decreased after the pandemic, leading to a reduction in the time to examination. Admitted patients benefitted from the pandemic with a reduction of 0.80 h in the length of stay in the ED, faster discharge without death, and reduced re-admission. However, non-admitted visits with chest pain increased the risk of mortality after the pandemic. In conclusion, the COVID-19 pandemic led to a significant reduction in low-acuity ED visits and improved prognoses for hospitalized patients. However, clinicians should be alert about patients with chest pain due to their increased risk of mortality in subsequent admission.

scholarly journals P124: The Ottawa Chest Pain Rule would increase stretcher capacity if implemented for cardiac chest pain patients

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S119-S119 ◽  
Author(s):  
M. Sonntag ◽  
E. Lang
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Patient Flow ◽  
System Capacity ◽  
Cardiac Monitoring ◽  
Convenience Sample ◽  
Heart Score ◽  
Number Of Patients ◽  
The Impact ◽  
Pain Patients

Introduction: Reducing the number of patients requiring cardiac monitoring would increase system capacity and improve emergency department (ED) patient flow. The Ottawa Chest Pain Rule helps physicians identify chest pain patients who do not require cardiac monitoring and is based on a ‘normal or non-specific’ ECG and being pain-free on initial physician assessment. Our objective was to measure the impact that the implementation of this decision rule would have on cardiac monitoring bed utilization in adult EDs in Calgary. Methods: A convenience sample of patients was prospectively obtained at each of the four Calgary adult emergency sites. All patients presenting with the Canadian Triage Acuity Scale chief complaint of “cardiac pain”, or “chest pain with cardiac features” were captured for inclusion in the study. Real time interviews and survey assessments were conducted with the primary nurse and physician involved in each patient’s care. Results: A total of 61 patients were captured by the study. Physicians identified cardiac as the primary rule-out pathology in 51% of these patients. The average Heart Score of all study patients was 4.2, and 30% of patients were ultimately admitted. Physicians believed that 39% of the 61 patients needed cardiac monitoring, while primary nurses believed that 59% needed monitoring. Of the 61 patients, 59% were triaged to areas providing cardiac monitoring. The application of the Ottawa Rule would have allowed 47% of patients triaged to cardiac monitoring to be taken off cardiac monitoring. This would translate to a total of greater than 74 hours saved or a reduction of 30% of the total cardiac monitored patient time. Conclusion: The Ottawa rule appears to be a low-risk emergency department flow intervention that has the potential to help reduce resource utilization in emergency departments. This change may result in increased emergency department capacity and improved overall patient flow. This simple rule based only on ECG findings and absence of chest pain can easily be applied and implemented without increasing physician workload or increasing risk to patients.

Correlation of Systolic Blood Pressure With the Improvement of Acute Coronary Syndrome Patients Admitted in the Emergency Department: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Jun Ke ◽  
Yiwei Chen ◽  
Xiaoping Wang ◽  
Zhiyong Wu ◽  
Qiongyao Zhang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Logistic Regression ◽  
Chest Pain ◽  
Systolic Blood Pressure ◽  
Unstable Angina ◽  
Independent Predictor ◽  
Coronary Syndrome ◽  
The Impact

Abstract Background: Blood pressure affects the clinical outcome of acute coronary syndrome (ACS) patients. However, it is not clear what level of blood pressure is beneficial to the improvement of ACS patients in emergency department. The purpose of this study is to analyze the impact of systolic blood pressure (SBP) on ACS patient’ improvement and transfer of patient from emergency department Methods: A total of 2667 patients who were admitted to the Emergency Department of Chest Pain Center, Fujian Provincial Hospital due to chest pain from January 1, 2017 to March 31, 2020 were included in the study. Logistic regression was used to analyze the correlation between SBP and ACS patients’ improvement in the emergency department, and the predictive effect on the disease improvement was evaluated. The study also analyzed the impact of SBP on the improvement of different subgroups of patients in the emergency department. Results: In total, 592 (22.20%) out of 2667 patients were improved and transferred to the general ward. Multivariate logistic regression analysis found that SBP = 120–140 mmHg (OR = 0.700; 95% CI: 0.510–0.961; P = 0.027) was an independent predictor for the decreased likelihood of improvement of ACS patients from the emergency department; SBP > 140 mmHg (OR = 1.348; 95% CI: 1.000-1.817; P = 0.049), use of clopidogrel (OR = 1.924; 95% CI: 1.247–2.971; P = 0.003), non-ST-segment elevation myocardial infarction (NSTEMI) (OR = 2.683; 95% CI: 1.645–4.375; P < 0.001) and unstable angina (OR = 23.654; 95% CI: 15.415–36.297; P < 0.001) were all independent predictors for the increased likelihood of improvement of ACS patients in the emergency department. The area under curve (AUC) of the predictive efficacy of SBP, combined with ticagrelor, NSTEMI and unstable angina (UA) was 0.814 (95% CI: 0.795–0.833, P < 0.001). Conclusion: The study found that SBP = 120–140 mmHg was an independent predictor for the decreased likelihood of improvement of ACS patients from the emergency department, but SBP > 140 mmHg was an independent predictor for the increased likelihood of improvement of ACS patients. This correlation may be useful for doctors to make clinical decisions for ACS patients.

The Impact of Pregnancy on the Work-Up of Chest Pain and Shortness of Breath in the Emergency Department [14Q]

2017 ◽  
Vol 129 ◽  
pp. 176S-177S
Author(s):  
Stephen Wagner ◽  
Ian Waldman ◽  
Allen R. Kunselman ◽  
Emily Smith ◽  
Timothy Deimling
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Shortness Of Breath ◽  
The Impact ◽  
Work Up

scholarly journals Emergency Department chest pain patient experience time (PET): the impact of ANP cardiology autonomy from triage to diagnosis

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
S Ingram
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Patient Experience ◽  
Audit Committee ◽  
Initial Assessment ◽  
Pain Patient ◽  
Waiting Room ◽  
Chest Pain Patient ◽  
The Impact ◽  
Pain Patients

Abstract Funding Acknowledgements Type of funding sources: None. Background Chest pain accounts for 8% of local Emergency Department (ED) presentations. Patient experience time (PET) is the entire time each patient spends in ED and the national ED PET goal is 6 - 9 hours. The Cardiology Advanced Nurse Practitioner (ANP) consult service reduced PET for patients with chest pain from 17 hours, however the average PET for patients presenting with chest pain remains high at 10 hours in 2019. Aim To assess the impact on of ANP Cardiology autonomy on the PET of chest pain patients who present to a busy ED. Method Building on 6 years of ANP chest pain consultations in the ED, cardiology ANPs expanded their caseload to fully manage chest pain patients directly from the waiting room as named clinicians, instead of an ED doctor.  The ANP managed the patient completely from triage to diagnosis, resulting in discharge or admission. Enablers included ANP referral for ionising radiation and medicinal prescribing, with buy in from ED Consultants and Cardiology clinical lead. All patients managed directly by the ANP from 2017-2019 were included in the data analysis. The ED symphony system was used as a clinical and audit tool. ANP chest pain PET was compared to ED Doctor chest pain PET. This service evaluation was approved by the hospital audit committee.  Results 197 patients who presented with chest pain were autonomously managed by one ANP as a named clinician over 3 years. Sixty-four percent were managed completely autonomously.  Eighty per cent were discharged from ED. ANP decision time from initial assessment to admit or discharge was 2.6 hours. The ANP average chest pain PET time was 7.5 hours compared to average ED doctor chest pain PET of 9.5 hours. Conclusions As social distancing now impacts more than ever on usual ED pressures, caseload expansion by the Cardiology ANPs evidences further PET reductions for patients who present with chest pain in line with targets. As only one ANP is on the floor and not every shift, many hours of the PET occurred in the ED prior to the ANP ‘clicking’ on as a named clinician. Professional courage to completely manage this potentially high risk cohort autonomously has been welcomed patients and ED staff. PET of the chest pain patient has the potential to reduce further with more ANPs proficient in chest pain assessment within the emergency department setting.

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