Nurse-led chest pain hot clinics: improving patient flow in the emergency department

Abstract

This article describes the authors' experiences of a specialist pathway for low-risk patients with chest pain admitted to the emergency department. This pathway uses a modified HEART score and highly sensitive troponin I testing to categorise patients. This was introduced to facilitate safe and speedy discharge of these patients within the 4-hour target. The aim was to demonstrate a reduction in length of stay and a reduction in overcrowding in the emergency department. This also included the introduction of a new nurse-led chest pain hot clinic to provide a specialist cardiology review within 72 hours of discharge. This clinic enabled more appropriate targeted investigation and treatment for patients. As a new initiative, it was important to ensure patient safety with a <1% incidence of major adverse cardiac event at 30 days, which was achieved. The modified HEART score also enabled more low-risk patients to be rapidly discharged from the emergency department. The chest pain hot clinics ensure patients are appropriately assessed and investigated for coronary artery disease reducing the number of unnecessary investigations. It also demonstrated a reduction in the number of computerised tomography coronary angiogram requests enabling more appropriate and timely investigations. In addition, there was a reduction in medical admissions and emergency department overcrowding. These initiatives also reduced the overall length of stay and increased the number of patients discharged within the 4-hour target from the emergency department.