Impact of initial triage decisions on nursing intensity for patients with acute chest pain

The results of a prospective evaluation of the patient-specific correlates of nursing intensity for 183 consecutive emergency room patients admitted for evaluation of acute chest pain, including 33 (18%) with acute myocardial infarction (AMI), are reported. These correlates were measured with a previously-validated, commercially-available patient classification tool (Medicus). In multiple linear regression analysis that adjusted for the effects of 31 clinical variables from the initial presentation and subsequent course, initial triage to the coronary care unit had a significant independent correlation with initial Medicus score (P less than 0.0001) and mean Medicus score from the first three days of hospitalization (P less than 0.0001). In a subset of 74 uncomplicated non-AMI patients, coronary care unit admissions were more likely to have vital signs taken every 2 hours, to receive oxygen therapy and assistance with feeding, and to be transferred to another unit within three days. Findings suggest that, after adjusting for severity of illness, initial triage of patients with acute chest pain to the coronary care unit is associated with increased nursing utilization because of 1) the routine application of standard coronary care unit protocols that were developed for high-risk patients, and 2) the nursing efforts required by early transfer of patients out of the coronary care unit.