The Great Western Hospitals NHS Foundation Trust Emergency Department, Cardiology and Blood Sciences Pathology units have created a chest pain pathway designed to help reduce patient waiting times in the Emergency Department.
The pathway, which has also proven to help with patient flow, has seen a 20% increase in patients who have presented with chest pain discharged within 4 hours, with 80% of patients now discharged in this time. Patients also have a far quicker wait time in ED when presenting with chest pain.
One of the key components of the pathway is the test for troponin, proteins that are measured in the blood to determine a heart attack. The key aspect of this test is that much lower levels of troponin can be detected much quicker, reducing the waiting time for the second troponin test from six hours to three hours. It is hoped that this will be reduced further to just one hour later this year. The high sensitivity troponin test also allows for gender specific testing which ensures that heart attacks are not being missed in females.
The troponin test also has financial benefits to the Trust, as it uses equipment already installed in the hospital’s blood science laboratory.
Dr Mayur Patel, Consultant in Chemical Pathology & Metabolic Medicine, said: “The high sensitivity Troponin test is able to detect much smaller amounts of troponin in the blood after a cardiac event. This allows earlier detection of a heart attack compared to the traditional test. Being the first Trust to introduce the Beckman test required us to work collaboratively with all relevant teams to ensure a safe and reliable pathway.”
The pathway also consists of the newly introduced Chest Pain Hot Clinics that enable some patients to be discharged following normal troponins and ECGs with a specialist nurse review within 72 hours. The specialist nurse has experience and skills in the assessment and management of patients with chest pain. They are able to assess, diagnose, treat and prescribe medications and also arrange for any further specialised investigations if required. They also work closely with the Cardiologists who provide additional support and expert advice when needed, which ensures patients are safe and reassured after discharge.
Jon Taylor, Advanced Clinical Practitioner for Cardiology Services, said: “Working alongside ED and Pathology has enabled us to provide a robust pathway that caters for all patients presenting with chest pain. The advantages of the new pathway are clear and many patients are benefitting from its service every day.”
