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

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.

PEMBERIAN TERAPI OKSIGEN PADA PASIEN ACUTE CORONARY SYNDROME DENGAN CHEST PAIN DI INSTALASI GAWAT DARURAT

Emergency nurses’s somehow actually routine use of supplemental oxygen theraphy in chest pain patient because of acute coronary syndrome is done, without know that routine oxygen theraphy may potentially cause harm. The used method was by collecting and analyzing related textbook and articles with the use of supplemental oxygen theraphy in chest pain patient because of acute coronary syndrome. The literatures were obtained from textbook and electronic articles such as ScienceDirect, World Health Organization, Google Scholar, PubMed and ClinicalKey with textbook and article criteria that were published from 2000 to 2015. The result is routine use of supplemental oxygen theraphy for Acute Coronary Syndrome (ACS) with chest pain based on physical assessment and level of oxygen saturation. The patient of ACS with chest pain without sign and symtoms hypoxia or respiratory distress, syok and heart failure with oxygen saturation ≥94% then without oxygen theraphy, if the patient with one or all of sign and symtoms above with oxygen saturation <94% then oxygen therapy can be given with initial administration is 4 L/minute and in titration until oxygen saturation ≥94% with administered more than than 6 hours. The next reassessment is done to the patient. If the condition of the airway patent, the patient can breathe spontaneously, normal breathing (especially rhythm, depth and no respiratory muscle use), respiratory or oxygenation problems minimally and oxygen saturation > 94% then oxygen therapy can be given with nasal cannul 4-6L / minute or simple mask from 6- 10L / minute. If the patient is emergency condition with airway patent, spontaneous breathing with adequate depth ventilation and requiring oxygen in high concentrations may then be provided with a non-rebreathing mask. The conclucion is routine use of supplemental oxygen theraphy in acute coronary syndrom with chest pain not recommended and the oxygen theraphy can be given if the patient with oxygen saturation <94% or sign and symtoms hypoxia or respiratory distress, breathlessness, syok and heart failure Key word :Acute Coronary Syndrome, Chest Pain, Emergency Unit, Oxygen Therapy