Accuracy in ED Triage for Symptoms of Acute Myocardial Infarction

Sanders, Susan F.; DeVon, Holli A.

doi:10.1016/j.jen.2015.12.011

Cited by 29 publications

(14 citation statements)

References 23 publications

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“…Therefore, these patients were triaged accurately, which was 80%, and got a level 2 designation, resulting in better triage accuracy in chest pain patients. According to previous reports, the BSN education level has been identified as positively affecting general patient results because the nursing purpose is triage-level designation decisions, which might lead to bad patient consequences 12,18 . BSN rather than R.N triaged almost 50% of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…In Pakistan, no proper triage system is developed, and no time limits and guidelines are defined for the completion of the triage process. The patient's assessment and a triage level designation is the triage goal representing symptoms urgency 12 . The Emergency Department can use ESI tool for accurate triage level to aid early interventions and affect patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of triage accuracy by Nurses, and delay care of acute myocardial infarction patients admitted to Emergency Department: retrospective analysis from Shifa International Hospital, Pakistan

Shabbir

Javeed

Kazmi

et al. 2021

Asian J. Health. Sci.

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Background: Coronary vascular disease (CVD) is the premier cause of fatality in the world. In Pakistan, 30 to 40% of all deaths occur due to CVD. The emergency department triage is carried out to prioritize the care of critical patients. Errors during triage may lead to mortality and morbidity of the patient. The current study's objective is to determine the triage process of acute myocardial infarction patients and its associated accuracy and delays during the acute myocardial infarction process of care in the emergency department. Methods: In this descriptive study, data were collected retrospectively from Shifa International Hospital. The consent was taken from participating Registered nurses (RNs) who were involved in the triage process. Nurses with experience of less than 1 year in the emergency department were not part of the study, while only those patients with symptoms indicative of Acute Myocardial Infarction and age of 21 years or older were included in the current study. EMR system was used on a daily basis as a method to capture data for the study. The actual clock time in minutes from arrival until triage and obtain ECG as greater than 10 minutes was identified as a delay. Results: The 8 R.N. participated in the current study with a mean age and experience of 28.11 years and 4.77 years. The patients' age was 22-74 years, which consist of 58.9% male and 41.1% female. Out of 224 patients, 20.53% of patients were smokers, 39.3% were diabetic, 44.6% were CVD, and 78.5% were reported for chest pain. Delay care such as the mean triage and ECG time recorded was 6.75, and 7.30 min, the mean E.R. physician and Cardiology resident assessment was 11 min and 25.19 min, respectively, which were significantly found according to the recommended guidelines of AHA. The triage accuracy in the current study was recorded as 80.35%. Conclusion: In Pakistan, no proper triage system is developed, and no time limits and guidelines are defined for the completion of the triage process. In the current study, the triage level designations, ECG delay, E.R. and cardiology resident assessment delay were found insignificant, and triage designation was found inaccurate with 19.6% of patients, which lead to delay the re-perfusion therapy. In patients with AMI symptoms, triage accuracy and quick ECG helps E.R. physician assessment to take a quick better decision for cardiac care. It helps patients to get re-perfusion therapy on time for acute myocardial infarction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of triage accuracy by Nurses, and delay care of acute myocardial infarction patients admitted to Emergency Department: retrospective analysis from Shifa International Hospital, Pakistan

Shabbir

Javeed

Kazmi

et al. 2021

Asian J. Health. Sci.

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“…3–6 Many factors have been cited for impacting on ECG delays (Figure 1) and these include registration processes; 3 patient demographics; 4 poor staff knowledge of ACS symptoms; 5 and inappropriate ACS triage acuity levels. 6 As delays to ECG acquisition may lead to delays in ACS diagnosis and treatment, 7,8 it is imperative that clinical pathways for ACS incorporate a system which supports timely ECG acquisition. The aim of this article is to report on the development and initial testing of a clinical prediction rule, to expedite the identification of patients who require an ECG within 10 min.…”

Section: Introductionmentioning

confidence: 99%

Towards prompt electrocardiogram acquisition in triage: Preliminary testing of a symptom-based clinical prediction rule for the Android tablet

O’Donnell

Monahan

McKee

et al. 2019

European Journal of Cardiovascular Nursing

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Background: For patients with suspected acute coronary syndrome, international guidelines indicate that an Electrocardiogram (ECG) should be performed within 10 min of first medical contact, however success at achieving these guidelines is limited. Aims: The purpose of this study was to develop and perform initial testing of a clinical prediction rule embedded in a tablet application, and to expedite the identification of patients who require an electrocardiogram within 10 min. Methods: This derivation of the Acute Coronary Syndrome Application (AcSAP) comprised of three local studies, an unpublished audit and literature critique. The AcSAP was prospectively tested over four months in patients presenting to the Emergency Department (ED) of a Dublin teaching hospital. An audit form retrieved data pertaining to times of: registration to the emergency department, triage, first electrocardiogram and diagnosis. The AcSAP was subsequently evaluated by experienced triage nurses (n=18) who had utilised it. Results: The AcSAP was activated 379 times. Patients with ST Elevation Myocardial Infarction (STEMI) and non-ST Elevation Myocardial Infarction (NSTEMI) were significantly more likely to return a categorisation of 'immediate ECG' or 'ECG within 10 min' (p<0.001). There was a significant difference in 'triage to ECG' times across categories, the 'immediate ECG' categorisation resulting in the shortest time (p=0.002). Evaluations suggest that staff found the tool quick and easy to use and results seemed accurate. Conclusion: Testing of the AcSAP suggests that it accurately identifies patients who require an ECG within 10 min. As such, it has the potential to support the meeting of clinical guidelines for ECG acquisition.

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“…[8] Therefore, it is essential that clinicians be well oriented about HF. [9] Fazel-Asgharpour et al [10] and Sanders et al [11] showed that 1.4% of HF patients was undertriaged. They showed that 1-day and 7-day mortality rate is 1.4% and 6.3% of patients who had been assigned to triage level 3 to 5, respectively.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, "high-risk situation" criteria mentioned in the second decision point of ESI is strictly dependent on the triage nurse's ability to fi nd a connection between the patient's condition and heart failure trajectory. Sanders et al [11] reported emergency nurses take care of patients with various probabilities of disease, so they may not be highly knowledgeable about HF risk factors particularly. It seems that there is a need for well oriented scales for HF patients in the ED.…”

Section: Introductionmentioning

confidence: 99%

Comparison between Emergency Severity Index and Heart Failure Triage Scale in heart failure patients: A randomized clinical trial

Pouyamehr

Mirhaghi

Sharifi

et al. 2019

World Journal of Emergency Medicine

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BACKGROUND: It is not clear whether Emergency Severity Index (ESI) is valid to triage heart failure (HF) patients and if HF patients benefi t more from a customized triage scale or not. The aim of study is to compare the effect of Heart Failure Triage Scale (HFTS) and ESI on mistriage among patients with HF who present to the emergency department (ED). METHODS:A randomized clinical trial was conducted from April to June 2017. HF patients with dyspnea were randomly assigned to HFTS or ESI groups. Triage level, used resources and time to electrocardiogram (ECG) were compared between both groups among HF patients who were admitted to coronary care unit (CCU), cardiac unit (CU) and discharged patients from the ED. Content validity was examined using Kappa designating agreement on relevance (K*). Reliability of both scale was evaluated using inter-observer agreement (Kappa). RESULTS:Seventy-three and 74 HF patients were assigned to HFTS and ESI groups respectively. Time to ECG in HFTS group was signifi cantly shorter than that of ESI group (2.05 vs. 16.82 minutes). Triage level between HFTS and ESI groups was signifi cantly different among patients admitted to CCU (1.0 vs. 2.8), cardiac unit (2.26 vs. 3.06) and discharged patients from the ED (3.53 vs. 2.86). Used resources in HFTS group was significantly different among triage levels (H=25.89; df=3; P<0.001). CONCLUSION: HFTS is associated with less mistriage than ESI for triaging HF patients. It is recommended to make use of HFTS to triage HF patients in the ED.

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Accuracy in ED Triage for Symptoms of Acute Myocardial Infarction

Cited by 29 publications

References 23 publications

Assessment of triage accuracy by Nurses, and delay care of acute myocardial infarction patients admitted to Emergency Department: retrospective analysis from Shifa International Hospital, Pakistan

Assessment of triage accuracy by Nurses, and delay care of acute myocardial infarction patients admitted to Emergency Department: retrospective analysis from Shifa International Hospital, Pakistan

Towards prompt electrocardiogram acquisition in triage: Preliminary testing of a symptom-based clinical prediction rule for the Android tablet

Comparison between Emergency Severity Index and Heart Failure Triage Scale in heart failure patients: A randomized clinical trial

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