Aims and Objectives: This article analyzes the literature describing factors affecting nurses' triage of emergency department (ED) patients with potential acute coronary syndrome (ACS), with particular attention paid to gender-based differences.
Introduction: Acute coronary syndrome is one of the most time-critical conditions requiring ED nurse triage. This literature review will provide examination of how triage nurses prioritize patients with possible ACS, reflecting on challenges specifically associated with evaluating women for ACS in the ED. The article presents a description of the research findings that may help improve the timely revascularization of ACS in women.
Methods: An electronic search of EBSCOhost CINAHL, Health Source Nursing Academic Edition, MEDLINE, Psychology and Behavioral Sciences Collection databases, online theses, the Cochrane Library, the Joanna Briggs Institute, and National Guideline Clearinghouse resources were used to identify all relevant scientific articles published between 1990 and 2010. Google and Google Scholar search engines were used to undertake a broader search of the World Wide Web to improve completeness of the search. This search technique was augmented by hand searching these articles' reference lists for publications missed during the primary search.
Results: Review of the literature suggests factors such as patient age, sex, and symptoms at ED presentation affect the accuracy of nurses' triage of ACS, particularly for women. However, research examining delays due to ED triage is scant and has predominantly been undertaken by one researcher. Little research has examined triage of ACS specifically in women.
Conclusions: The literature search revealed a small number of articles describing challenges associated with nurse triage of women with ACS. Although most of this published research is North American, the themes uncovered are well supported by broader international research on acute assessment and management of women's ACS. These include the following: gender-based differences in the presentation of ACS can preclude early identification of ACS, advanced patient age often correlates with missed or delayed diagnosis of ACS, and there appears to be a general bias against managing women for ACS in parity with men's disease.
Relevance to Practice: Early reperfusion therapy is critical for optimal health outcomes in ACS. Triage nurses are ideally placed to minimize time to treatment for ACS. An understanding of the issues related to clinical decision making and triage allocation of women with ACS at triage is necessary to ensure appropriate treatment.
Lisa Kuhn, DipAppSci(Nurs), EmergCert, GradDip(Nurs), MHlthSci(Nurs), RN PhD Candidate, Faculty of Health Sciences, School of Nursing and Midwifery, Australian Catholic University; and St Vincent's Centre for Nursing Research, St Vincent's Public Hospital, Melbourne, Australia.
Karen Page, MN, DN, BEd, GradDipAdvNurs(CritCare), RN Associate Professor of Research, Faculty of Health Sciences, School of Nursing and Midwifery, Australian Catholic University; and St Vincent's/ACU Centre for Nursing Research, St Vincent's Public Hospital, Melbourne, Australia.
Patricia M. Davidson, PhD, MEd, BA, RN Professor of Cardiovascular and Chronic Care, School of Nursing and Midwifery, Curtin University of Technology, Sydney, Australia.
Linda Worrall-Carter, PhD, BEd, CoronaryCareCert, RN Professor and Director of Nursing Research, Faculty of Health Sciences, School of Nursing and Midwifery, Australian Catholic University; and St Vincent's/ACU Centre for Nursing Research, St Vincent's Public Hospital, Melbourne, Australia.
The authors wish to acknowledge support received by Ms Kuhn in the form of an Australian Postgraduate Award with stipend administered by Australian Catholic University and a grant from the Royal College of Nursing, Australia National Research and Scholarship Fund.
The authors have no conflicts of interest to report.
Correspondence Lisa Kuhn, DipAppSci(Nurs), EmergCert, GradDip(Nurs), MHlthSci(Nurs), RN, VECCI Building, Locked Bag 4115, Fitzroy MDC 3065, Level 4, 486 Albert St, East Melbourne 3002, Australia (firstname.lastname@example.org).