Emergency department (ED) nurses are in a key position to initiate life-saving recommendations for myocardial infarction, which include a physician-read electrocardiogram (ECG) within 10 min of ED arrival. Using a quasi-experimental, one-group pretest—posttest design, the authors evaluated the preliminary effectiveness of the Aid to Cardiac Triage (ACT) intervention to improve ED nurses’ cardiac triage decisions. Charts of all women who received an ED ECG 3 months before ( n = 171) and after (n = 184) the intervention and who were at least 18 years of age were reviewed. A 1-hr educational session was conducted to improve nurses’ (n = 23) cardiac triage decisions. Postintervention, the proportion of women receiving an ECG within 10 min of ED arrival improved, as did the odds of women receiving a timely ECG. Preliminary evaluation of the ACT intervention indicates its effectiveness at improving ED nurses’ cardiac triage decisions and obtaining a 10-min physician-read ECG.
American Heart Association. (2009). Get With the Guidelines. Retrieved from http://www.americanheart.org/presenter.jhtml?identifier=1165
2.
Anand, S.S., Xie, C.C., Mehta, S., Grazia Franzosi, M., Joyner, C., Chrolavicius, S., et al. (2005). Differences in the management and prognosis of women and men who suffer from acute coronary syndromes. Journal of the American College of Cardiology, 46, 1845-1851. doi:10.1016/j.jacc.2005.05.091
3.
Antman, E.M., Anbe, D.T., Armstrong, P.W., Bates, E.R., Green, L.A.Hand, M., et al. (2004). ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction-Executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). Journal of the American College of Cardiology, 44, 671-719. doi:10.1016/j.jacc.2004.07.002
4.
Arslanian-Engoren, C. ( 2000). Gender and age bias in triage decisions. Journal of Emergency Nursing, 26, 117-124. doi:10.1016/S0099-1767(00)90053-9
5.
Arslanian-Engoren, C. ( 2001). Gender and age differences in nurses’ triage decisions using vignette patients. Nursing Research, 50, 61-66.
6.
Arslanian-Engoren, C. ( 2004). Do emergency nurses’ triage decisions predict admission or discharge diagnoses for acute coronary syndromes? Journal of Cardiovascular Nursing, 19, 280-286.
7.
Arslanian-Engoren, C. ( 2005). Patient cues that predict nurses’ triage decisions for acute coronary syndromes. Applied Nursing Research, 18, 82-89. doi:10.1016/j .apnr.2004.06.013
8.
Arslanian-Engoren, C., Hagerty, B.M., Antonakos, C.L., & Eagle, K.A. (in press). The feasibility and utility of the Aid to Cardiac Triage (ACT) Intervention: Improving nurses’ cardiac triage decisions. Heart & Lung.
9.
Bergelson, B.A., & Tommaso, C.L. ( 1995). Gender differences in clinical evaluation and triage in coronary artery disease. Chest, 108, 1510-1513. doi:10.1378/ chest.108.6.1510
10.
Bradley, E.H., Herrin, J., Wang, Y., Barton, B.A., Webster, T.R., Mattera, J.A., et al. (2006). Strategies for reducing door-to-balloon time in acute myocardial infarction. New England Journal of Medicine, 355, 2308-2320.
11.
Braunwald, E., Antman, E.M., Beasley, J.W., Califf, R.M., Cheitlin, M.D., Hochman, J.S., et al. (2002). ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction . Journal of the American College of Cardiology, 40, 1366-1374. doi:10.1016/S0735-1097(02)02336-7
12.
Daudelin, D.H., & Selker, H.P. ( 2005). Medical error prevention in ED triage for ACS: Use of cardiac care decision support and quality improvement feedback. Cardiology Clinics, 23, 601-614. doi:10.1016/j.ccl.2005.08.004
13.
ED Nursing. ( 2005). Are cardiac patients waiting too long in your ED? Cut dangerous delays now. ED Nursing, 8(4), 37-39.
Gerdtz, M.F., & Bucknall, T.K. (2001). Triage nurses’ clinical decision making. An observational study of urgency assessment. Journal of Advanced Nursing, 35, 550-561. doi:10.1046/j.1365-2648.2001.01871.x
16.
Griffith, D., Hamilton, K., Norrie, J., & Isle, C. ( 2005). Early and late mortality after myocardial infarction in men and women: Prospective observational study. Heart, 91, 305-307. doi:10.1136/hrt.2003.033035
17.
Hamilton, D.L., & Rose, T.L. ( 1980). Illusory correlation and the maintenance of stereotypic beliefs. Journal of Personality and Social Psychology, 39, 832-845.
18.
Houston, D.A., & Fazio, R.H. ( 1989). Biased processing as a function of attitude accessibility: Making objective judgments subjectively. Social Cognition , 7, 51-66.
19.
Institute of Medicine. (2003). Unequal treatment: Confronting racial and ethnic disparities in healthcare . Washington, DC: The National Academies Press.
20.
Kordish, C., Albinger, D., Crouch, S., & Kerwin, P. ( 2008). Cardiac alert: Decreasing door to balloon time for ST elevation myocardial infarction. Journal of Emergency Nursing , 34, 116-120. doi:10.1016/j.jen.2007.04.010
21.
Lee, T.H., Pearson, S.D., Johnson, P.A., Garcia, T.B., Weisberg, M.C., Guadagnoli, E., et al. (1995). Failure of information as an intervention to modify clinical management: A time-series trial in patients with acute chest pain. Annals of Internal Medicine, 122, 434-437.
22.
Lehmann, J.B., Wehner, P.S., Lehmann, C.U., & Savory, L.M. ( 1996). Gender bias in the evaluation of chest pain in the emergency department. American Journal of Cardiology, 77, 641-644. doi:10.1016/S0002-9149(97)89322-8
23.
Mahon, N.G., McKenna, C.J., Codd, M.B., O’Rorke, C., McCann, H.A., & Sugrue, D.D. ( 2000). Gender differences in the management and outcome of acute myocardial infarction in unselected patients in the thrombolytic era. American Journal of Cardiology, 85, 921-926.
24.
O’Donnell, S., Condell, S., Begley, C., & Fitzgerald, T. (2005). In-hospital care pathway delays: Gender and myocardial infarction. Journal of Advanced Nursing, 52, 14-21. doi:10.1111/j.1365-2648.2005.03559.x
25.
Pedhazur, E.J. ( 1997). Multiple regression in behavioral research (3rd ed.). Orlando, FL: Harcourt Brace.
26.
Phelan, M.P., Mahone, P., Martin, C., Matteo, S., Brener, B., Morgan, W.F., et al. (2007). Improving door-to-ECG time in ST-elevation myocardial infarction (STEMI) [Abstract]. Annals of Emergency Medicine, 50, S111-S112.
27.
Pope, J.H., Aufderheide, T.P., Ruthazer, R., Woodlord, R.H., Feldman, J.A., Beshansky, J.R., et al. (2000). Missed diagnoses of acute cardiac ischemia in the emergency department. New England Journal of Medicine , 342, 1163-1170.
28.
Purim-Shem-Tov, Y.A., Rumoro, D.P., Veloso, J., & Zettinger, K. ( 2007). Emergency department greeters reduce door-to-ECG time . Critical Pathways in Cardiology, 6, 165-168. doi:10.1097/HPC.0b013e31812da7a6
29.
Rathore, S.S., Chen, J., Wang, Y., Radford, M.J., Vaccarino, V., & Krumholz, H.M. (2001). Sex differences in cardiac catheterization: The role of physician gender. Journal of the American Medical Association, 286, 2849-2856. doi:10.1001/jama.286.22.2849
30.
Rhee, K.J., Donabedian, A., & Burney, R.E. ( 1987). Assessing the quality of care in a hospital emergency unit: A framework and its application. Quality Review Bulletin , 13, 4-16.
31.
Ryan, T.J., Antman, E.M., Brooks, N.H., Califf, R.M., Hillis, L.D., Hiratzka, L.F., et al. (1999). 1999 Update: ACC/AHA guidelines for the management of patients with acute myocardial infarction: 1999 update: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on management of acute myocardial infarction) . Journal of the American College of Cardiology, 34, 890-911. doi:10.1016/S0735-1097(99)00351-4
32.
Sánchez, M., López, B., Bragulat, E., Gómez-Angelats, E., Jiménez, S., Ortega, M., et al. (2007). Triage flowchart to rule out acute coronary syndrome. American Journal of Emergency Medicine, 25, 865-872. doi:10.1016/j.ajem.2006.12.025
33.
Sarasin, F.P., Reymond, J.M., Griffith, J.L., Beshansky, J.R., Schifferli, J.A., Unger, P.F., et al. (1994). Impact of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) on the speed of triage decision making for emergency department patients presenting with chest pain: A controlled clinical trial. Journal of General Internal Medicine, 9, 187-194.
34.
Schulman, K.A., Berlin, J.A., Harless, W., Kerner, J.F., Sistrunk, S., Gersh, B.J., et al. (1999). The effect of race and sex on physicians’ recommendations for cardiac catheterization. New England Journal of Medicine, 340, 618-626.
35.
Scott, J.W. ( 1992). Experience. In J. Butler & J. W. Scott (Eds.), Feminists theorize the political (pp. 22-40). London, UK: Routledge, Chapman & Hall.
36.
Selker, H.P., Beshansky, J.R., Griffith, J.L., Aufderheide, T.P., Ballin, D.S., Bernard, S.A., et al. (1998). Use of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) to assist with triage of patients with chest pain or other symptoms suggestive of acute cardiac ischemia: A multicenter, controlled clinical trial. Annals of Internal Medicine, 129, 845-855.
37.
Tanabe, P., Gimbel, R., Yardond, P., & Adams, J.G. ( 2004). The Emergency Severity Index (version 3) 5-level triage system scores predict ED resource consumption. Journal of Emergency Nursing, 30, 22-29.
38.
Tanabe, P., Gimbel, R., Yardond, P.R., Kyriacou, D.N., & Adams, J.G. ( 2004). Reliability and validity of scores on the Emergency Severity Index version 3. Academic Emergency Medicine, 11, 59-65.
39.
Thomas, T., & Walsh, R. ( 2006). Increasing nurses awareness of the acute coronary guidelines for patients in a progressive care unit. Critical Care Nurse , 26(2), S12.
40.
Tversky, A., & Kahneman, D. ( 1973). Availability: A heuristic for judging frequency and probability . Cognitive Psychology, 5, 207-232.
41.
Tversky, A., & Kahneman, D. ( 1974). Judgment under uncertainty: Heuristics and biases. Science, 185, 1124-1131. doi:10.1126/science.185.4157.1124
42.
Tversky, A., & Kahneman, D. ( 1982). Judgment under uncertainty: Heuristics and biases. In D. Kahneman, P. Slovic, & A. Tversky (Eds.), Judgment under uncertainty: Heuristics and biases (pp. 3-20). Cambridge , UK: Cambridge University Press.
43.
Venkat, A., Hoekstra, J., Lindsell, C., Prall, D., Hollander, J.E., Pollack, C.V., Jr., et al. (2003). The impact of race on the acute management of chest pain. Academic Emergency Medicine, 10, 1199-1208. doi:10.1197/S1069-6563(03)00490-1
