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Cardiac monitoring in a community hospital. Analysis of 18 months' experience
Insights
Implementing cardiac monitoring in community hospitals, with nurses leading resuscitation efforts, significantly reduced myocardial infarction mortality. This approach proved vital for salvaging patients with electrical disturbances.
Area of Science:
- Cardiology
- Critical Care Medicine
- Nursing Practice
Background:
- Cardiac monitoring facilities have been established in teaching hospitals for over five years.
- A significant reduction in mortality has been observed in monitored patients with acute myocardial infarction.
- Community hospital systems present unique challenges to effective cardiac monitoring due to multiple physicians and varied therapies.
Purpose of the Study:
- To evaluate the effectiveness of a community hospital cardiac monitoring unit.
- To assess the impact of nurse-led emergency care and resuscitation on myocardial infarction mortality.
- To identify key factors contributing to successful patient outcomes in a community hospital setting.
Main Methods:
- Implementation of a cardiac monitoring unit in a community hospital over 18 months.
- Majority of emergency care and resuscitation performed by nurses.
- Utilization of standing orders for nurses and required practice privileges within the unit.
- Acceptance of nurses as therapists in emergency situations.
Main Results:
- Mortality from myocardial infarction was 16.6% in the community hospital monitoring unit.
- Fourteen patients were successfully resuscitated and discharged.
- Ventricular fibrillation due to digitalis intoxication was treated in four patients.
- Patients with shock and severe congestive heart failure remain a clinical challenge.
Conclusions:
- Nurse-led cardiac monitoring and resuscitation in community hospitals can significantly decrease myocardial infarction mortality.
- Standing orders and nurse empowerment are crucial for successful emergency cardiac care.
- While electrical disturbances are often salvageable, shock and severe congestive heart failure require further clinical solutions.
Abstract:
Cardiac monitoring facilities have been present in teaching hospital centers for over five years. A substantial decrease in mortality has been observed in monitored patients with acute myocardial infarction. The community hospital system offers a challenge to effective monitoring since many physicians care for patients and often many kinds of therapy are used. After 18 months of operation mortality from myocardial infarction was only 16.6 percent in a community hospital monitoring unit where the majority of the emergency care and resuscitation was carried out by nurses. Vital to this success was the use of standing orders for nurses, requirement of privilege to practice within the monitoring facility and acceptance of the nurse as a therapist in emergency situations.Fourteen patients were successfully resuscitated and were later discharged from the hospital. Four of them had ventricular fibrillation from digitalis intoxication. Patients with shock and severe congestive heart failure continue to be a major unsolved clinical problem. The results indicate that the potentially viable patient with serious electrical disturbances can almost invariably be salvaged.