Effectiveness of Using the Front Door Score to Enhance the Chest Pain Triage Accuracy of Emergency Nurse Triage Decisions

Capability of emergency nurses for electrocardiogram interpretation

INTRODUCTION

Electrocardiogram is the first-line diagnostic imaging modality for evaluating patients with chest pain. The present study aimed to determine the capability of emergency nurses for electrocardiogram interpretation by using a more appropriate questioning method.

METHODS

This was a cross-sectional descriptive survey. A convenience sample of 96 emergency nurses was obtained from two emergency departments in Hong Kong. The electrocardiogram-interpretation capability of the emergency nurses was determined using a self-developed well-designed questionnaire comprising 10 questions on electrocardiogram interpretation. Each question carried one point, such that the maximum score was 10 points. The higher the score, the more capable was the emergency nurse at electrocardiogram interpretation.

RESULTS

The mean score achieved by the participants was 7.7 ± 1.8. Only 12.5% of the participants were able to answer all questions correctly. A considerable proportion of the participants were unable to recognize first-degree heart block (74.0%), second-degree heart block type I (52.1%), or third-degree heart block (39.6%). Gender, electrocardiogram training, nursing experience, and emergency department experience had significant associations with mean score.

CONCLUSIONS

The electrocardiogram-interpretation capability of the emergency nurses was fair. Better training should be implemented to help emergency nurses recognize potentially fatal heart blocks, enabling prompt and appropriate patient treatment.

Exploring the complex interactions of baseline patient factors to improve nursing triage of acute coronary syndrome

Emergency department (ED) nurses need to identify patients with potential acute coronary syndrome (ACS) rapidly because treatment delay could impact patient outcomes. Aims of this secondary analysis were to identify key patient factors that could be available at initial ED nurse triage that predict ACS. Consecutive patients with chest pain who called 9-1-1, received a 12-lead electrocardiogram in the prehospital setting, and were transported via emergency medical service were included in the study. A total of 750 patients were recruited. The sample had an average age of 59 years old, was 57% male, and 40% Black. One hundred and fifteen patients were diagnosed with ACS. Older age, non-Caucasian race, and faster respiratory rate were independent predictors of ACS. There was an interaction between heart rate by Type II diabetes receiving insulin in the context of ACS. Type II diabetics requiring insulin for better glycemic control manifested a faster heart rate. By identifying patient factors at ED nurse triage that could be predictive of ACS, accuracy rates of triage may improve, thus impacting patient outcomes.