A Nationwide Study of Emergency Department Nurses’ Triage Decisions for Patients with Potential Acute Coronary Syndrome

Purpose: : To explore emergency department (ED) nurses’ triage decisions for patients presenting with possible acute coronary syndrome (ACS).

Design: : A descriptive, cross-sectional design was used.

Setting:: A stratified random sample of registered nurses from the Emergency Nurses Association (ENA) membership were included. The study survey was posted on the ENA website, and participants were encouraged to share the study link with their professional networks.

Sample:: Inclusion criteria were (a) must be a registered nurse, (b) work at least part-time in the ED, (c) the ability to complete an online Qualtrics survey, (d) fluent in English, and (e) perform triage in the ED.

Methods: : Participants completed an anonymous Qualtrics survey, including relevant demographic questions, one question about angina assessment/screening, and the Nurses’ Cardiac Triage Instrument. Data were analyzed using descriptive statistics.

Results: : A final sample of 414 was recruited from across the United States. Participants were a mean of 41.7±12.0 years, had a median 8.0 (IQR 11.0) years of ED nursing experience, and about half (49.5%) were certified emergency nurses. Participants worked in EDs of various sizes, with 53.1% having 31 or more beds. A total of 54.6% of the EDs represented were certified chest pain centers.

Based on a 5-point Likert scale from “none of the time” (1) to “all of the time” (5), participants reported that severity of chest pressure (MDN 5.0) and the nature of chest pain (MDN 5.0) served as the two most common cues to identify patients with potential ACS. Patient gender (MDN 2.0), presence of a fever (MDN 2.0), and marital status (MDN 1.0) were reportedly used the least. To query patients about possible angina, participants most often reported using the terms “chest pain” (79.5%), “chest pressure” (77.3%), “chest tightness” (72.9%), and “chest discomfort” (72.5%).

Once a patient with potential ACS was identified, participants reported that their highest priorities were to obtain a physician read 12-lead electrocardiogram (ECG) within 10 minutes (MDN 5.0) and to get the patient to the cardiac catheterization laboratory (MDN 5.0), if necessary. Nearly all participants (94.9%) reported that after they determine a patient may be experiencing ACS that they obtain a physician-read 12-lead ECG within 10 minutes.

Implications:: These findings confirm that the ED triage process for ACS across the United States are generally based on the patients report of chest symptoms. This may disadvantage patients without chest pain and those experiencing less frequently reported symptoms such as sweating, shoulder pain, and fatigue. The finding that triage decisions were not based on gender is heartening and may help reduce sex disparities in cardiac care. Future research should explore the degree to which reported triage decision-making strategies match actual clinical practice and affect patient care and patient outcomes.