Do emergency nurses' triage decisions predict differences in admission or discharge diagnoses for acute coronary...

Area of Science:

• Cardiology
• Emergency Medicine
• Nursing Research

Background:

• Coronary heart disease (CHD) is a leading cause of death in the U.S., with women experiencing higher mortality rates after acute coronary events.
• Women often receive less aggressive treatment for acute coronary events compared to men, contributing to disparities in outcomes.
• Emergency nurses play a critical role in initial patient triage, influencing the urgency and direction of cardiac care.

Purpose of the Study:

• To investigate whether emergency nurses' initial triage decisions can predict the subsequent admission or discharge diagnoses of acute coronary syndromes (ACS).

Main Methods:

• A prospective study analyzed 108 triage decisions made by 13 emergency nurses.
• Multivariate analysis identified predictors of an ACS diagnosis, including chest pain, history of CHD, history of myocardial infarction, and smoking.
• Patient demographics (gender, race, age) were assessed for influence on triage decisions.

Main Results:

• Nurses' triage decisions did not differ based on patient gender, race, or age.
• The accuracy of triage decisions in predicting admission diagnosis was poor (Sensitivity 57%, Specificity 59%).
• Predicting discharge diagnosis also showed poor accuracy (Sensitivity 55%, Specificity 69%), with a very low positive predictive value (17%).

Conclusions:

• Emergency nurses' initial triage decisions have significant limitations in accurately predicting admission and discharge diagnoses for patients with suspected acute coronary syndromes.
• These findings suggest a need to re-evaluate and potentially enhance current emergency nursing triage protocols for cardiac patients to improve diagnostic accuracy and reduce disparities.