Date of Award

Spring 2-14-2012

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Cecelia M. Grindel, PhD, RN, FAAN

Second Advisor

Ptlene Minick, PhD, RN

Third Advisor

Holli DeVon, PhD, RN

Abstract

More than 6 million people present to emergency departments (EDs) across the US annually with chief complaints of chest pain or other symptoms suggestive of acute myocardial infarction (AMI). Of the million who are diagnosed with AMI, 350,000 die during the acute phase. Accurate triage in the ED can reduce mortality and morbidity, yet accuracy rates are low and delays in patient care are high. The purpose of this study was to explore the relationship between (a) patient characteristics, registered nurse (RN) characteristics, symptom presentation, and accuracy of ED RN triage level designations and (b) delay of care of patients with symptoms suggestive of AMI. Constructs from Donabedian’s Structure-Process-Outcome model were used to guide this study.

Descriptive correlational analyses were performed using retrospective triage data from electronic medical records. The sample of 286 patients with symptoms suggestive of AMI comprised primarily Caucasian, married, non-smokers, of mean age of 61 with no prior history of heart disease. The sample of triage nurses primarily comprised Caucasian females of mean age of 45 years with an associate’s degree in nursing and 11 years’ experience in the ED.

RNs in the study had an accuracy rate of 54% in triage of patients with symptoms suggestive of AMI. The older RN was more accurate in triage level designation. Accuracy in triage level designations was significantly related to patient race/ethnicity. Logistic regression results suggested that accuracy of triage level designation was twice as likely (OR 2.07) to be accurate when the patient was non-Caucasian. The patient with chest pain reported at triage was also twice as likely (OR 2.55) to have an accurate triage than the patient with no chest pain reported at triage. Electrocardiogram (ECG) delay was significantly greater in the patient without chest pain and when the RN had more experience in ED nursing. Triage delay was significantly related to patient gender and race/ethnicity, with female patients and non-Caucasian patients experiencing greater delay. An increase in RN years of experience predicted greater delay in triage. Further studies are necessary to understand decisions at triage, expedite care, improve outcomes, and decrease deaths from AMI.

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