Description and development of a nurse-led cardiac assessment team

Abstract

A problem was identified where patient care was affected because of delays in receiving specialist cardiology input. This report describes the experience of developing a specialist cardiac assessment where senior cardiac nurses were trained to provide a 24-hour presence in the emergency department (ED). We describe the service and our evaluation of the service. These dedicated specialised nurses can optimise patient management including admission or safely discharge patients with relevant follow-up when necessary. The team also runs three clinics per week with consultant support. The team of 10 nurses provides a cardiology opinion to approximately 400 patients a month in the ED and 100 patients a month in the acute medical unit (AMU). Eighty-seven per cent of patients are seen in the ED within 30 minutes of referral. Approximately 40% of patients reviewed are accepted directly into cardiology beds thus avoiding admission to the AMU. It has been estimated that 6 bed-days are saved each day, which translated to an estimated £400,000 each year. The team also provides outpatient rapid access services which generates £121,792 income for the directorate. We demonstrate that a cardiac nurse assessment team can provide a cost-effective 24-hour presence in the ED.

Keywords: Nursing; cardiac assessment team; cardiology.

Fig. 1.

Patient flow prior to the development of the cardiac specialist nurse team. AMU = acute medical unit; ED = emergency department; IP = inpatient; OP = outpatient; SHO = senior house officer.

Fig. 2.

Cardiac assessment nurse training programme. IRMER = Ionising Radiation (Medical Exposure) Regulations.

Fig. 3.

Patient flow after the development of the cardiac specialist nurse team. ED = emergency department; IP = inpatient; OP = outpatient.