Can a nurse trained in coronary care expedite emergency department management of patients with acute coronary syndromes?
OBJECTIVE
The goal of this study was to determine the effect of a coronary care-trained nurse (CCTN) on transfer times of patients presenting with acute coronary syndromes (ACS) from the emergency department (ED) to the coronary care unit (CCU) for definitive cardiac treatment (DCT).


METHODS
This was a prospective randomized controlled study.


METHODS
The study took place in the ED of a metropolitan public teaching hospital in South Australia.


METHODS
The study sample was comprised of 893 patients who presented to the ED with a complaint of chest pain.


METHODS
An experienced senior CCTN was randomly assigned to work in an ED for 16 randomly selected hours per week; comparable hours over the same period without a CCTN in attendance were used as control data. The major endpoint was time to CCU transfer where DCT was completed for patients with ACS.


RESULTS
Out of 893 patients assessed as having possible ACS, 91 (10%) were admitted to the CCU, 47 with a diagnosis of unstable angina pectoris (UAP) and 44 with a diagnosis of acute myocardial infarction. Nineteen patients required thrombolysis and/or percutaneous coronary angioplasty. Mean times (in minutes) to transfer for DCT (95% CI) were 102 (70-134) and 117 (95-139) in the presence and absence of a CCTN, respectively, for all ACS, and 33 (10-55) and 54 (25-82), respectively, for acute myocardial infarction requiring thrombolysis and/or percutaneous coronary angioplasty.


CONCLUSIONS
These pilot data show a nonsignificant trend suggesting that DCT is expedited by assignment of senior CCTNs to EDs and provides direction for further study.
Kucia
A M
AM
Coronary Care Unit of The Queen Elizabeth Hospital, Adelaide, Australia.
Taylor
K T
KT
Horowitz
J D
JD
D000208:Acute Disease; D003325:Coronary Care Units; D003327:Coronary Disease / Q000451:nursing*; D016529:Emergency Nursing; D006801:Humans; D009726:Nurses; D010865:Pilot Projects; D011446:Prospective Studies; D013996:Time and Motion Studies