Improving the Referral of Patients With Chest Pain (Urgent)
Acute Coronary Syndrome, Myocardial Infarction, Chest Pain
About this trial
This is an interventional diagnostic trial for Acute Coronary Syndrome
Eligibility Criteria
Inclusion Criteria:
All patients with chest pain or other complaints suspect of acute coronary syndrome (ACS) can be included in which the general practitioner is in need of further diagnostics to come to a decision of referral.
All patients referred to the emergency department (ED) with suspected ACS will be included to evaluate the appropriateness of referral.
Exclusion Criteria:
- Patients younger than 18 years
- Patients in which a typical history and/or physical examination requires immediate referral; high suspicion of ACS
- Patients in which an acute non-coronary diagnosis is suspected, e.g. pulmonary embolism, thoracic aortic dissection etc.
The baseline of patients seen at the ED will not exclude any patients referred with suspected ACS.
Sites / Locations
- VieCuri Medical Center
Arms of the Study
Arm 1
Arm 2
Arm 3
Other
No Intervention
No Intervention
General practitioner diagnosis with Heart score
Triage Nurse education
Baseline registry as comparison
Patients with chest pain who are reviewed by the general practitioner (GP) at the GP cooperation will be evaluated with the Heart score to support the GP with the diagnosis.
The general practitioner cooperation employs nurses for (telephone) triage. They are aided by a computer based triage system, the Netherlands triage system (NTS), a 6-level urgency triage system. With this study we aim to educate the nurses in the signs and symptoms of chest pain patients. The training program will aim to educate the triage nurses in acute coronary syndrome, including pathophysiology, symptoms and risk factors. The NTS will be incorporated within the training. The triage nurses will receive a training session by Cardiologists with information about acute coronary syndrome, the symptoms and the risks.
All patients referred to the emergency department (ED) with suspected acute coronary syndrome (ACS) will be evaluated. They will receive a questionnaire to evaluate the accuracy of referral and the delays of ACS patients. This will be compared to the registry at baseline. Some patients will either have not contacted the general practitioner cooperation (GPC) at all, or will have been referred to the ED directly through the GPC nurse triage. The 30 day, 6 months and one year follow-up of all patients will be via medical records, or in case of no or not enough information, by telephone.