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Graff L, Palmer AC, LaMonica P, et al. Triage of patients for a rapid (5-minute) electrocardiogram: A rule based on presenting chief complaints. Ann Emerg Med 2000; 36:554-560.
Using a rule based on the patient’s chief complaint can identify patients with myocardial infarction (MI) for immediate electrocardiogram (ECG), according to this study from New Britain (CT) General Hospital and the University of Connecticut Medical School in Farmington. The study determined five chief complaints to be the most likely to identify patients with acute MI:
Using the rule, ECGs are performed on appropriate patients immediately after their arrival in the ED. "This bypasses the usual delay during the nursing triage assessment and the queuing that occurs for patients waiting to see the triage nurse," write the researchers. "The goal is to meet the national standard of overall less than 30 minutes of delay in the administration of thrombolytic agents."
Of 193 patients who had one of these chief complaints, 142 had the final diagnosis of MI. Going by the rule based on five chief complaints was more effective than chest pain in identifying patients for a "stat" ECG. Over the four-year study period, the following outcomes improved after the rule was implemented:
Implementation of a rule for ordering immediate ECGs makes it easier to create a clinical path for rapid treatment of patients with acute MI with thrombolytic agents, the researchers argue. "It goes beyond the traditional assessment process and defines an imperative for treatment without delay," they write.
Cole FL, Ramirez E. Activities and procedures performed by nurse practitioners in emergency care settings. J Emerg Nurs 2000; 26:455-463.
Although half of the nurse practitioners in EDs performed 35 out of 71 activities and procedures, they believed that a larger skill set is needed for practice, says this study from the University of Texas Health Science Center in Houston. The study surveyed 72 nurse practitioners who worked in EDs, asking them to rate 71 activities and procedures according to how often they performed them. Here are key findings:
The study was the first to determine what activities and procedures are being done by nurse practitioners in multiple emergency care settings. The study’s findings should be used in the following ways, recommend the researchers:
Nguyen HB, Rivers EP, Havstad S, et al. Critical care in the emergency department: A physiologic assessment and outcome evaluation. Acad Emerg Med 2000; 7:1354-1361.
Although the period of care provided in the ED for critically ill patients is brief, it significantly impacts morbidity and mortality, according to this study from Henry Ford Hospital and Case Western Reserve University in Detroit. Physiologic determinants of outcome may be established before the patient is admitted to the ICU, which underscores the importance of ED intervention, the researchers assert.
There was a significant reversal of physiologic derangement during ED intervention, the study found. Admission to the ICU was avoided for 11.1% of the patients after ED therapy, who were instead admitted to the general ward. This finding suggests that ED therapy can play a role in preventing disease progression and ICU resource utilization, say the researchers.
The researchers argue that unique physiologic assessment methodologies should be developed to assess the quality of patient care and measure the impact of clinical interventions and pathways in the ED. These models should include the following, the researchers recommend: