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Clinical Articles, Lead Article

Assessment unit improves management of patients with chest pain

Lengths of stay and ward admissions for patients presenting with chest pain can be reduced, and rapid referral for patients with positive findings ensured, through the introduction of a Chest Pain Assessment Unit (CPAU), according to findings at Forth Valley Royal Hospital.

The CPAU is intended to act as a gatekeeper for the cardiac unit, reducing unnecessary referrals and ensuring rapid escalation of care, if required. Staffed by a consultant nurse, or advanced nurse practitioner, and a staff nurse, the Unit offers robust assessment and clinical supervision and works closely with consultants in the cardiac unit.

Chest pain accounts for a significant proportion (around 25%) of acute medical admissions at Forth Valley, but in the majority of these cases (around 70%), acute coronary syndrome (ACS) is excluded. The average length of stay for such patients was 24–36 hours, which incurred a significant cost to the acute operating division and had a large impact on bed capacity.

Since the CPAU opened the length of time patients with chest pain spend in the emergency department has been reduced by 50% and their overall length of stay in hospital has been reduced by 44%. The majority of patients (>90%) are able to be discharged from the unit, while the remainder are escalated more quickly.  Three snapshot (one month) 30-day discharge mortality studies have shown zero mortalities since the unit has been in operation.

The cobas h 232 system for Troponin T testing at the point of care

The cobas h 232 system for Troponin T testing at the point of care

“Prior to opening the CPAU patients at low risk of ACS were spending a long time in hospital unnecessarily, often overnight, while ACS was ruled out, ” explains Nurse Consultant – Acute Medicine, Sharon Oswald. “To obtain real-time results that enable rapid decisions to be made, we introduced the Roche cobas h 232 system for point of care Troponin T testing…Before we introduced it, Troponin T tests were batched and performed four times per day in the laboratory. There were sometimes delays in getting the bloods to the laboratory and then in getting results back.  Now…we are able to obtain results in real time, which allows faster decision making.”

Published on: June 20, 2013

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  • ArrhythmiaAlliance
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