The Effects of a Practice Guideline of Chest Pain Triage on Accuracy and Nurses’ Satisfaction at The Out-Patient Department

Abstract

Background: Chest pain is a prevalent condition worldwide. A review of current data at Thammasat University Hospital revealed a 0.02 percent error rate in symptom-based screening, resulting in incorrect department assignments. Notably, misdirected chest pain cases often lead to severe outcomes, accounting for 6.6 percent of these errors.

Objective: This study aims to assess the impact of implementing chest pain screening guidelines for outpatient nurses at Thammasat University Hospital.

Material and methods: The sample group consisted of 5 professional nurses who screened patients with chest pain symptoms 65 persons. The tools used in this study consisted of 1) clinical practice guideline for the screening of chest pain symptoms in outpatients developed according to the Iowa Seven-Step Clinical Guideline Development Guidelines, 2) an outpatient chest pain symptoms screening form that passed the verification from 3 qualified experts by using the Index of Item-Objective Congruence method equal to 0.9.  This study evaluates the use of practice guidelines for pain syndrome screening. The data were analyzed using descriptive statistics, and the results obtained through guideline usage were compared using chi-square statistics.

Result: The study found that the accuracy of chest pain syndrome screening significantly improved after implementing the guidelines. The accuracy rate increased from 75.38% before guideline implementation to 90.77% afterward (p<0.05). Additionally, the rate of rejected referrals decreased from 24.62% to 9.23% following guideline implementation, also with statistical significance (p< 0.05).

Conclusion: The improved accuracy of screening is likely attributed to comprehensive history-taking practices, guideline-based decision-making support, and screening symptoms. This positively impacted patient referrals, reducing under-triage and complications while awaiting evaluation.