Why the study?
Does clinical risk assessment by emergency department nurses compare to emergency department doctors in accuracy for patients with suspected acute coronary syndrome?
Does clinical risk assessment by emergency department nurses compare to emergency department doctors in accuracy for patients with suspected acute coronary syndrome?
Emergency department nurses and doctors demonstrate similar but suboptimal accuracy in clinical risk assessment for suspected acute coronary syndrome, highlighting the need for standardized clinical pathways.
Background: Patients with chest pain represent a large portion of emergency department (ED) presentations around the world. Accurate risk assessment to rule out acute coronary syndrome (ACS) is required. Aim: To measure accuracy and characteristics of ED doctors and nurses when assessing patients for suspected ACS and the associations with outcome. Methods: A sub-analysis of a large randomised trial that compared high-sensitivity troponin to conventional troponin was carried out. Both nurses and doctors conducted ACS risk assessments on 1857 patients and concordance comparisons were undertaken. Findings: There was no difference between the accuracy of ED nurses and doctors (c-statistic: 0.67 vs 0.68 respectively; P=0.35). Both clinician types made similar ACS risk assessments. Nurses with specialist qualifications and consultant doctors were the most accurate, at 65.4% and 74.2%, respectively. Conclusion: Nurses and doctors in the ED made similar ACS risk assessments but both were sub-optimal. Standard clinical pathways to assist ED doctors and nurses improve their ACS impression accuracy could be beneficial.
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Chapple et al. (2018) studied this question.
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