Chest Pain Centers
Nurses who work in chest pain centers find rich rewards amid an often hectic environment. Focusing on rapid diagnosis, getting patients to treatment qucikly, ensuring EMS crews know signs and symptoms, and ensuring staff members are up-to-date on new treatments are all challenges for nurses working in chest pain centers.
"We focus on door-to-balloon time in less than 90 minutes. The sooner you restore blood flow, that much more of the myocardium is being saved. Time is muscle," said Denise Stimpfle, BSN, RN, assistant nurse manager, cardiac cath lab, Washington Adventist Hospital, Takoma Park, MD.
The hospital is one of four facilities ADVANCE interviewed that are accredited by the Society of Chest Pain Centers (SCPC). The designation is awarded to hospitals that demonstrate expertise and commitment to quality patient care by meeting or exceeding stringent criteria and completing on-site evaluations by a SCPC review team.
Those criteria include the following:
• integrating the emergency department with local EMS providers;
• assessing, diagnosing and treating patients quickly;
• effectively treating patients who are at low-risk for acute coronary syndrome and have no assignable cause for their symptoms;
• continually seeking to improve processes and procedures;
• ensuring chest pain center personnel competency and training;
• maintaining organizational structure and commitment;
• having a functional design that promotes optimal patient care; and
• supporting community outreach programs that educate the public to promptly seek medical care if they display symptoms of a possible heart attack.
A classic example might involve a patient who arrives by ambulance presenting with symptoms of an MI, said Laura Brown, BSN, RN, clinical manager, Peninsula Regional Medical Center, Salisbury, MD.
An ambulance crew transporting a patient can initiate a "code STEMI" from the field, and the patient goes through the ED and directly to the cath lab. Other patients experiencing chest pain might come on their own to the ED, and then a rapid triage will be activated.
From there, the ED physician contacts a cardiologist and the two physicians jointly decide whether to admit the patient or discharge to home. Treatments can range from cath lab intervention or a stress test to overnight observation.
'So Much Diversity'
"It's a wonderful position. There's so much diversity as a nurse," said Claire Brown, BSN, RN, CCM, manager of cardiovascular network development, AtlantiCare Regional Medical Center, which has campuses in Atlantic City and Pomona, NJ.
She has helped develop teaching tools for students from kindergarten to high school, as well as presentations for community centers and senior facilities. Hospital staff membes often lead the education sessions.
As AtlantiCare's chest pain center coordinator, Brown also helped the ED develop chest pain protocol pathways and assisted with physician order sets. She is involved in vascular screenings, teaches nurses about acute coronary syndrome, and helps train new RNs and medical residents.
'Excellent Care'
"My job is to ensure a patient has a safe procedure and an excellent clinical outcome," Washington Adventist's Stimpfle said. The veteran nurse is adept at ensuring patients have the smoothest procedural course.
"A lot of it is talking people through the process and reassuring them. I'll stand at the head of the table while the doctor is getting arterial access. Communication is key to getting patients through the primarily acute phase of the procedure," she said.
Making a Difference
"The rapid pace can be stressful, but it's always rewarding. Most days, I leave my job knowing I made a difference," said Karla Clark, RN, CCRN, RCS, team leader, adult echocardiography lab, and coordinator, advanced cardiovascular imaging, Geisinger Medical Center, Danville, PA.
Clark's unit sees patients following intervention in the cath lab. Within 24 hours, staff will treat that patient in the echo lab - anything from a stress test to noninvasive cardiac imaging - to rule out coronary disease.
Geisinger's average door-to-balloon time is 42 minutes from the time the patient comes through the ED doors. If the patient arrives from a referring hospital or via helicopter, the time is about 88 minutes, Clark said.
Brown and her staff at Peninsula Regional handle pre- and postop care in the cath and electrophysiology labs. Nurses caring for the preop patient concentrate on the admissions process, assessment, patient chart information and educating the patient about the procedure. Once the procedure is completed, staff focuses on activity guidelines, medication changes and discharge instructions.
They also educate patients on the risk factors of heart disease, preventing heart failure, and the roles of diet and exercise. Cardiac rehab staff participate in education and facilitation of these patients into outpatient/secondary preventive services.
Karin Lillis is senior regional editor at ADVANCE.