Abstract
Introduction: Patients with undifferentiated chest pain constitute a large proportion of emergency room (ER) presentations, creating a
significant resource burden. Currently timely and accurate risk assessment by doctors is required to rule out suspected acute coronary
syndrome(ACS). Nurses may assist to streamline this process. The aim was to compare the accuracy of doctors and nurses assessing
patients for suspected ACS and associations with outcome.
Methods: A sub-analysis of 1,857 patients with chest pain presenting to 5 Australian hospital ERs was conducted from a randomised
trial evaluating the impact of high-sensitivity troponin versus conventional troponin reporting and the effect on unguided application to
care and outcome. Participating nurses and doctors estimated patient ACS likelihood and recorded their professional characteristics.
Clinician assessment associated with adjudicated ACS discharge diagnosis and 7-day major adverse clinical event outcomes were
measured, with concordance comparisons conducted.
Results: Six hundred and nine clinicians participated and 16% of patients had a diagnosis of ACS. There was no significant difference in
risk assessment accuracy of ER nurses compared to doctors (C-statistic: 0.67 vs. 0.68 respectively; p=0.35). In patients diagnosed with
ACS, both clinician types were correct and agreed ACS was definite/likely in 202 (66%) cases and were incorrect and agreed ACS was
unlikely in 69 (23%) of cases. In patients with a non-ACS diagnosis, both clinician types agreed and were correct in 531 (34%) of cases
and agreed but were incorrect ACS was definitely/likely in 815 (53%) of cases. One patient had a major adverse clinical event at 7 days.
Specialty trained nurses and consultant doctors were associated with higher risk assessment accuracy (specialty nurses: 65.4% vs
55.3%) and (consultant doctors: 74.0 % vs 60.3%).
Conclusion: Both nurses and doctors were poor predictors of an ACS diagnosis when assessing undifferentiated chest pain patients.
Standardised pathways that guide decision-making may improve accuracy for both clinician types and doctor versus nurse assessment
in this context needs further study
significant resource burden. Currently timely and accurate risk assessment by doctors is required to rule out suspected acute coronary
syndrome(ACS). Nurses may assist to streamline this process. The aim was to compare the accuracy of doctors and nurses assessing
patients for suspected ACS and associations with outcome.
Methods: A sub-analysis of 1,857 patients with chest pain presenting to 5 Australian hospital ERs was conducted from a randomised
trial evaluating the impact of high-sensitivity troponin versus conventional troponin reporting and the effect on unguided application to
care and outcome. Participating nurses and doctors estimated patient ACS likelihood and recorded their professional characteristics.
Clinician assessment associated with adjudicated ACS discharge diagnosis and 7-day major adverse clinical event outcomes were
measured, with concordance comparisons conducted.
Results: Six hundred and nine clinicians participated and 16% of patients had a diagnosis of ACS. There was no significant difference in
risk assessment accuracy of ER nurses compared to doctors (C-statistic: 0.67 vs. 0.68 respectively; p=0.35). In patients diagnosed with
ACS, both clinician types were correct and agreed ACS was definite/likely in 202 (66%) cases and were incorrect and agreed ACS was
unlikely in 69 (23%) of cases. In patients with a non-ACS diagnosis, both clinician types agreed and were correct in 531 (34%) of cases
and agreed but were incorrect ACS was definitely/likely in 815 (53%) of cases. One patient had a major adverse clinical event at 7 days.
Specialty trained nurses and consultant doctors were associated with higher risk assessment accuracy (specialty nurses: 65.4% vs
55.3%) and (consultant doctors: 74.0 % vs 60.3%).
Conclusion: Both nurses and doctors were poor predictors of an ACS diagnosis when assessing undifferentiated chest pain patients.
Standardised pathways that guide decision-making may improve accuracy for both clinician types and doctor versus nurse assessment
in this context needs further study
| Original language | English |
|---|---|
| Publication status | Published - 13 Nov 2017 |
| Event | American Heart Association Scientific Sessions 2017 (AHA) - Anaheim, United States Duration: 11 Nov 2017 → 15 Nov 2017 |
Conference
| Conference | American Heart Association Scientific Sessions 2017 (AHA) |
|---|---|
| Country | United States |
| City | Anaheim |
| Period | 11/11/17 → 15/11/17 |
Bibliographical note
AHA Scientific Sessions 2017 ; Conference date: 11-11-2017 Through 15-11-2017Keywords
- Risk Assessment
- Acute Coronary Syndrome
- Standardised pathways