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Chen Y, Kunst E, Nasrawi D, Massey D, Johnston ANB, Keller K, Fengzhi Lin F. Nurses' competency in electrocardiogram interpretation in acute care settings: A systematic review. J Adv Nurs 2022; 78:1245-1266. [PMID: 34989423 DOI: 10.1111/jan.15147] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/03/2021] [Accepted: 12/18/2021] [Indexed: 12/22/2022]
Abstract
AIMS Identify and synthesize evidence of nurses' competency in electrocardiogram interpretation in acute care settings. DESIGN Systematic mixed studies review. DATA SOURCES Cumulative Index to Nursing and Allied Health Literature, Medline, Scopus and Cochrane were searched in April 2021. REVIEW METHODS Data were selected using the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. A data-based convergent synthesis design using qualitative content analysis was adopted. Quality appraisal was undertaken using validated tools appropriate to study designs of the included papers. RESULTS Forty-three papers were included in this review. Skills and attitudes were not commonly assessed, as most studies referred to 'competency' in the context of nurses' knowledge in electrocardiogram interpretation. Nurses' knowledge levels in this important nursing role varied notably, which could be partly due to a range of assessment tools being used. Several factors were found to influence nurses' competency in electrocardiogram interpretation across the included studies from individual, professional and organizational perspectives. CONCLUSION The definition of 'competency' was inconsistent, and nurses' competency in electrocardiogram interpretation varied from low to high. Nurses identified a lack of regular training and insufficient exposure in electrocardiogram interpretation. Hence, regular, standard training and education are recommended. Also, more research is needed to develop a standardized and comprehensive electrocardiogram interpretation tool, thereby allowing educators to safely assess nurses' competency. IMPACT This review addressed questions related to nurses' competency in electrocardiogram interpretation. The findings highlight varying competency levels and assessment methods. Nurses reported a lack of knowledge and confidence in interpreting electrocardiograms. There is an urgent need to explore opportunities to promote and maintain nurses' competency in electrocardiogram interpretation.
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Affiliation(s)
- Yingyan Chen
- School of Health and Human Sciences, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
| | - Elicia Kunst
- School of Health and Human Sciences, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
| | - Dima Nasrawi
- School of Health and Human Sciences, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
| | - Debbie Massey
- School of Health and Human Sciences, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
| | - Amy N B Johnston
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia.,Department of Emergency Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Kathryn Keller
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, United States
| | - Frances Fengzhi Lin
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Queensland, Australia.,Sunshine Coast Health Institute, Birtinya, Queensland, Australia
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Whitman M, D'souza AS, Jenkins C, Sabapathy S, Challa P. Safety and Efficacy of Scientist Led Exercise Stress Testing for Arrhythmia Provocation and Chronotropic Competence. Am J Cardiol 2021; 154:63-66. [PMID: 34233835 DOI: 10.1016/j.amjcard.2021.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Abstract
For many years, non physician led exercise stress testing performed for the investigation of coronary artery disease has been endorsed by many cardiovascular (CV) societies and associations around the world. The safety guidelines don't currently include the performing of these tests for arrhythmia provocation or chronotropic assessment. Therefore, the aim of this study was to assess the safety and efficacy of non physician led EST performed for suspected arrhythmias, chronotropic competence, long QT, and accessory pathway conduction (APC) assessment. A total of 486 patients performed an exercise stress test for either of the above suspected conditions and were followed for 1.8 years ± 1.5 years. Tests were performed by a trained cardiac scientist with all reports over-read by a consultant Cardiologist. There were no significant adverse events (myocardial infarction, arrhythmia causing hemodynamic compromise or syncope) at time of testing. A total of 12.1% of patients required further follow up consisting of either a cardiac pacemaker, an implantable cardioverter defibrillator, radiofrequency ablation, Direct-Current cardioversion or a change in medications. Interobserver agreement between the Cardiologist and cardiac scientist was 98.4% indicating excellent agreement. In conclusion, the present study demonstrates that cardiac scientists can safely perform non physician led EST for the investigation of suspected arrhythmias, chronotropic competence, long QT, and APC assessment with a diagnostic interpretation equivalent to that of a consultant Cardiologist.
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Patel S, Alshami A, Douedi S, Campbell N, Hossain M, Mushtaq A, Tarina D, Sealove B, Kountz D, Carpenter K, Angelo E, Buccellato V, Sable K, Frank E, Asif A. Improving Hospital Length of Stay: Results of a Retrospective Cohort Study. Healthcare (Basel) 2021; 9:healthcare9060762. [PMID: 34205327 PMCID: PMC8234441 DOI: 10.3390/healthcare9060762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/12/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Jersey Shore University Medical Center (JSUMC) is a 646-bed tertiary medical center located in central New Jersey. Over the past several years, development and maturation of tertiary services at JSUMC has resulted in tremendous growth, with the inpatient volume increasing by 17% between 2016 and 2018. As hospital floors functioned at maximum capacity, the medical center was frequently forced into crisis mode with substantial increases in emergency department (ED) waiting times and a paradoxical increase in-hospital length of stay (hLOS). Prolonged hLOS can contribute to worse patient outcomes and satisfaction, as well as increased medical costs. (2) Methods: A root cause analysis was conducted to identify the factors leading to delays in providing in-hospital services. Four main bottlenecks were identified by the in-hospital phase sub-committee: incomplete orders, delays in placement to rehabilitation facilities, delays due to testing (mainly imaging), and delays in entering the discharge order. Similarly, the discharge process itself was analyzed, and obstacles were identified. Specific interventions to address each obstacle were implemented. Mean CMI-adjusted hospital LOS (CMI-hLOS) was the primary outcome measure. (3) Results: After interventions, CMI-hLOS decreased from 2.99 in 2017 to 2.84 and 2.76 days in 2018 and 2019, respectively. To correct for aberrations due to the COVID pandemic, we compared June-August 2019 to June-August 2020 and found a further decrease to 2.42 days after full implementation of all interventions. We estimate that the intervention led to an absolute reduction in costs of USD 3 million in the second half of 2019 and more than USD 7 million in 2020. On the other hand, the total expenses, represented by salaries for additional staffing, were USD 2,103,274, resulting in an estimated net saving for 2020 of USD 5,400,000. (4) Conclusions: At JSUMC, hLOS was found to be a complex and costly issue. A comprehensive approach, starting with the identification of all correctable delays followed by interventions to mitigate delays, led to a significant reduction in hLOS along with significant cost savings.
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Affiliation(s)
- Swapnil Patel
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
- Correspondence:
| | - Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Natasha Campbell
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Mohammad Hossain
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Arman Mushtaq
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Dana Tarina
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Brett Sealove
- Department of Cardiology, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA;
| | - David Kountz
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
| | - Kim Carpenter
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
| | - Ellen Angelo
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
| | - Vito Buccellato
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
| | - Kenneth Sable
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
| | - Elliot Frank
- Department of Quality Improvement, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA;
| | - Arif Asif
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
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Whitman M, Padayachee C, Tilley P, Sear C, Rosanoff S, El Shinawi H, Manolis C, Jenkins C, Challa P. Scientist-led Exercise Testing Is Safe With Diagnostic Interpretation Equivalent to a Cardiologist. Crit Pathw Cardiol 2020; 19:14-17. [PMID: 31490210 DOI: 10.1097/hpc.0000000000000193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The implementation of nonphysician-led exercise stress testing (EST) has increased over the last 30 years, with endorsement by many cardiovascular societies around the world. The comparable safety of nonphysician-led EST to physician-led studies has been demonstrated, with some studies also showing agreement in diagnostic preliminary interpretations. OBJECTIVE The study aim was to firstly confirm the safety of nonphysician-led EST in a large cohort and secondly compare the interobserver agreement and diagnostic accuracy of cardiac scientist and junior medical officer (JMO)-led EST reports to cardiology consultant overreads. METHODS All ESTs performed between 1/7/2010 and 30/6/2013 were included in the study for JMO led tests (n = 1332). ESTs performed for the investigation of coronary artery disease between 1/7/2013 and 30/6/2016 were included for scientist-led testing (n = 1904). RESULTS There was one adverse event, an ST segment myocardial infarction during the recovery phase of a JMO-led EST. Interobserver agreement was superior between the cardiologist and the scientist compared with the cardiologist and the JMO (P < 0.0001). Sensitivity for JMO-led tests differed from the cardiologist overread (86.96% vs. 96.77%, P = 0.03). There were no other significant differences between the cardiologist overread and the JMO- or scientist-led interpretation. CONCLUSIONS Scientist-led EST is safe in intermediate risk patients and their preliminary reports are equally diagnostic as cardiologist overreads. While JMO-led ESTs are just as safe, the preliminary reports differ significantly from cardiologist overread particularly with respect to sensitivity.
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Affiliation(s)
- Mark Whitman
- From the Cardiac Investigations Unit, Logan Hospital, Meadowbrook, Australia
- Menzies Health Institute, Queensland, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Cliantha Padayachee
- From the Cardiac Investigations Unit, Logan Hospital, Meadowbrook, Australia
| | - Prue Tilley
- From the Cardiac Investigations Unit, Logan Hospital, Meadowbrook, Australia
| | - Casey Sear
- From the Cardiac Investigations Unit, Logan Hospital, Meadowbrook, Australia
| | - Shelley Rosanoff
- From the Cardiac Investigations Unit, Logan Hospital, Meadowbrook, Australia
| | - Hadeir El Shinawi
- From the Cardiac Investigations Unit, Logan Hospital, Meadowbrook, Australia
| | - Christiana Manolis
- From the Cardiac Investigations Unit, Logan Hospital, Meadowbrook, Australia
| | - Carly Jenkins
- From the Cardiac Investigations Unit, Logan Hospital, Meadowbrook, Australia
| | - Prasad Challa
- From the Cardiac Investigations Unit, Logan Hospital, Meadowbrook, Australia
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Abstract
Exercise stress testing is a non-invasive procedure that provides diagnostic and prognostic information for the evaluation of several pathologies, including arrhythmia provocation, assessment of exercise capacity, and coronary heart disease. Historically, exercise tests were directly supervised by physicians; however, cost-containment issues and time constraints on physicians have encouraged the use of health professionals with specific training and experience to supervise selected exercise stress tests. Evidence suggests that non-physician-led exercise stress testing is a safe and effective practice with similar morbidity and mortality rates as those performed or supervised by a physician.
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Palmer JL, Coats MA, Roe CM, Hanko SM, Xiong C, Morris JC. Unified Parkinson's Disease Rating Scale-Motor Exam: inter-rater reliability of advanced practice nurse and neurologist assessments. J Adv Nurs 2010; 66:1382-7. [PMID: 20546368 DOI: 10.1111/j.1365-2648.2010.05313.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This paper is a report of a study to establish the inter-rater reliability of advanced practice nurse and neurologist neurological assessments which included ratings with the Unified Parkinson's Disease Rating Scale-Motor Exam. BACKGROUND Around the world, advanced practice nurses are performing tasks once completed only by physicians. To promote consumer and provider confidence, it is important to establish that nurse and physician ratings using assessment tools are similar. In addition in research settings, when different raters are used, establishment of inter-rater reliability for study assessments is needed. METHOD Advanced practice nurses and neurologists independently recorded findings on neurological examinations of 46 participants in a study conducted between August 2007 and January 2008. An intraclass correlation coefficient was calculated to estimate overall agreement between the nurse and neurologist ratings. Agreement for individual items measured on a dichotomous scale was assessed by calculating Cohen's kappa. RESULTS There was substantial agreement between advanced practice nurses and neurologists on the mean Unified Parkinson's Disease Rating Scale-Motor Exam ratings (intraclass correlation coefficient = 0.65) and the U.S. National Alzheimer's Coordinating Center Uniform Data Set neurological examination ratings of unremarkable findings (kappa = 0.74) and of gait disorder (kappa = 0.73). Moderate agreement (kappa = 0.53) was reached for the rating of whether all Unified Parkinson's Disease Rating Scale-Motor Exam items were normal. CONCLUSION These findings are consistent with studies of the inter-rater agreement of the Unified Parkinson's Disease Rating Scale-Motor Exam and support the conduct of neurological assessments by advanced practice nurses.
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Affiliation(s)
- Janice L Palmer
- Saint Louis University School of Nursing, St Louis, Missouri, USA.
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