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Discharge of Non–Acute Coronary Syndrome Chest Pain Patients From Emergency Care to an Advanced Nurse Practitioner–Led Chest Pain Clinic: A Cross-Sectional Study of Referral Source and Final Diagnosis

Ingram, Shirley J. RGN, NFESC, MSc; McKee, Gabrielle BA, PhD; Quirke, Mary B. PhD; Kelly, Niamh RGN, MSc; Moloney, Ashling RGN, HDip

Journal of Cardiovascular Nursing: March/April 2017 - Volume 32 - Issue 2 - p E1–E8
doi: 10.1097/JCN.0000000000000374
Feature Article/Online Only

Background: Chest pain is a common presentation to emergency departments (EDs). Pathways for patients with non–acute coronary syndrome (ACS) chest pain are not optimal. An advanced cardiology nurse–led chest pain service was commenced to address this. The aim of the study was to assess the outcomes of non-ACS patients discharged from ED to an advanced cardiology nurse–led chest pain clinic and compare by referral type (nurse or ED physician).

Methods: The service consisted of advanced cardiology nurse or ED physician consultation in the ED and discharge to advanced nurse–led chest pain clinic review less than 72 hours after discharge. Referrals were by the advanced nurses during consult hours and out-of-hours were by the ED physicians. Data were extracted from case notes. This was a 1-site cross-sectional study of patients attending the chest pain clinic over 2 years.

Results: Confirmed coronary disease was diagnosed in 24% of patients. Of the 1041 patients, 45% were referred by the advanced nurses, who referred significantly more patients who were older (56.5 years/52.3 years), had positive exercise stress test results (21%/12%), and were diagnosed with stable coronary artery disease (19%/11%) and less patients with musculoskeletal diagnosis (5%/13%) and other noncardiac pain (36%/45%).

Conclusions: The study fills a gap in the literature on the follow up of non-ACS patients who present to ED and used advanced cardiology nursing expertise in the ED and chest pain clinic. The advanced nurse referred more patients who were diagnosed with coronary disease, reflecting the expertise, experience, and efficiency of the advanced cardiology nurse–led service.

Shirley J. Ingram, RGN, NFESC, MSc Registered Advanced Nurse Practitioner (RANP) Cardiology, Department of Cardiology Nursing, Tallaght Hospital, Dublin, Ireland.

Gabrielle McKee, BA, PhD Associate Professor, Biological Sciences Nursing, School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland.

Mary B. Quirke, PhD Research Fellow, Trinity Centre for Practice and Healthcare Innovation/Tallaght Hospital School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland.

Niamh Kelly, RGN, MSc Advanced Nurse Practitioner Cardiology Candidate (ANPc), Department of Cardiology Nursing, Tallaght Hospital, Dublin, Ireland

Ashling Moloney, RGN, HDip Clinical Nurse Specialist Cardiology (CNS), Department of Cardiology Nursing, Tallaght Hospital, Dublin, Ireland.

The authors have no funding or conflicts of interest to disclose.

Correspondence Shirley Ingram, RGN, NFESC, MSc, Department of Cardiology, Tallaght Hospital, Dublin 24, Ireland (

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