Discharge of Non–Acute Coronary Syndrome Chest Pain Patients From Emergency Care to an Advanced Nurse Practitioner–Led Chest Pain Clinic

Abstract

Background: Chest pain is a common presentation to emergency departments (ED).

A survey of nurse practitioner perceptions of integration into acute care organisations across one region in Ireland

“…There is a dearth of literature related to nurse practitioner referral patterns nationally and internationally. The only Irish research related to nurse practitioner referral (Ingram et al, 2017) reporting on the efficiency of referral from ED to a specialized chest pain clinic in a single centre. Comparing the outcomes of nurse practitioner referrals to their health care colleagues are also reported in other specialist areas (Gelinne et al, 2019; Liddy et al, 2016).…”

Implementation and Outcomes of an Advanced Nurse Practitioner Telephone Chest Pain Clinic Developed in Response to the COVID-19 Pandemic

“…There were more appropriate referrals to the clinic in the pre-pandemic period (85% vs 77%), indicating the benefit of the nurse-led assessment in ED. 26 There was a significantly greater proportion of patients with dyspnea (although there were few) assessed in the AVC in 2020, suggesting that exclusion of nonangina equivalent dyspnea (eg, dyspnea due to asthma, chronic obstructive pulmonary disease, pulmonary embolism) proved to be more challenging in the COVID-19 pandemic environment Both obstructive (any stenosis ≥70% or left main stenosis ≥50% 27 ) and nonobstructive CAD were diagnosed in both cohorts with no significant difference between face-to-face and virtual visits. Diagnostics rates are comparable with the ESC-documented outcomes of patients who present to ED with chest pain, 4 demonstrating the effectiveness of both clinics in providing patient care.…”

Rapid access chest pain clinics in Australia and New Zealand

“…The difference in referral pathways is likely a contributing factor in divergent diagnostic rates — in the UK 4–16% of RACC patients have ACS, whereas in Australia and New Zealand these patients have been largely ruled out through their initial ED presentation 2 . In addition, RACCs in the UK have implemented effective nurse practitioner‐led models 30,31 …”

“…2 In addition, RACCs in the UK have implemented effective nurse practitioner-led models. 30,31 Similar to Australia and New Zealand, RACCs in the UK have a variety of first line investigations, including stress imaging modalities such as exercise stress testing, stress echocardiogram or myocardial perfusion scans and anatomical imaging such as CTCA. In the UK, with an update to the National Institute for Health and Care Excellence stable chest pain clinical guideline in 2016, there is a deliberate move towards CTCA as the first line test.…”