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Accelerated Low Risk Cardiac Symptom Protocol

By Donna Taylor, RN, Cardiovascular Nurse Navigator

What do you do when you think you are having a heart attack? Hopefully, your answer would be call 9-1-1! But we understand the hesitation. It could just be indigestion, it could be stress, it could be any number of things - and, you don't want to clog up the Emergency Department (ED), or spend hours waiting when you aren't sure, right?

Well, unless you get checked out by a health professional, you will never know. And, you could potentially avoid a life-threatening situation later down the road. What's more? The wait is over.

For those who think that they be experiencing a heart attack, we have developed a special protocol called the "Accelerated Low Risk Cardiac Symptom Protocol. " Patients experiencing chest pain symptoms or other early signs of a heart attack are observed and treated in the Main Emergency Department.

Upon arrival, a clinician runs through a series of questions and tests with the patient to calculate a Thrombolysis in Myocardial Infarction Score or TIMI Score. The lower the score, the lower the risk for heart attack. It the patient's score is greater than 2, they will be immediately admitted to the hospital and a cardiology consultation will be ordered. If the patient's score is less than 2, a series of tests and observation will begin. Three periodic EKGs are performed and interpreted by an Emergency physician for abnormality and blood tests are run at three-hour intervals to test for Troponin. Troponin is a protein released when there is damage to the heart muscle. An increase would indicate the beginnings of a heart attack.

If at any time during treatment a patient experiences abnormal vital signs, abnormal EKGs or an increase in troponin levels, the Emergency Room physician would admit the patient to the hospital and a Cardiologist would be consulted.

This protocol originated through a collaboration of Emergency physicians, Cardiologists and Directors at Chester County Hospital to decrease the length of time patients with symptoms of early heart attacks spend in the ED and, if needed, get them the appropriate treatment as soon as possible. Prior to the development of this protocol, many patients experiencing cardiac symptoms were admitted to the hospital and observed over a longer period of time to ensure there was no heart damage related to the episode of pain.

With this new protocol, patients who remain stable with normal EKGs and troponin levels are discharged by the emergency physician with follow-up provided by the hospital's Cardiovascular Nurse Navigator (See Cardiac Nurse Navigator). The Nurse Navigator reaches out to discharged patients to discuss cardiac risk factors and helps to expedite an appointment with a cardiologist within 72 hours. The Nurse Navigator is also available to patients as an ongoing resource for education, information and support.

Since this protocol has been implemented, Chester County Hospital patients are overall satisfied to get the care they need in a timely manner while avoiding a hospital stay.

Last Updated: 2/6/2014