Proposed Solution
The diagnostic limitations of the electrocardiographic testing and serum markers make the traditional examination of patients with undifferentiated acute chest pain inconclusive. The proposed solution for this problem is the organization of a specialized unit with all the necessary measurement and laboratory equipment and qualified personnel for the purpose of distributing the health care resources more effectively and improving the quality of the services.
The innovative chest pain unit (CPU) approach to monitoring and diagnosing the patients with acute chest pain which can be consistent with acute coronary syndrome (ACS) is beneficial for reducing the physicians’ risk of misdiagnosing and increasing the patients’ satisfaction with the health care services. The implementation of the CPU method requires reorganization of the whole hospital setting and/or emergency department (ED).
It is important to explore the opportunities and evaluate the potential risks before developing the action plan, the implementation of the project requires buying all the necessary equipment and training the nursing and laboratory staff, deepening their knowledge of the measurement methods and improving their practical skills. The steps required for realization of the plan include the exploratory and planning components for detecting the necessary measures and evaluating the potential risks before proceeding to actions.
Implementation of the innovative CPU approach requires reorganization of the whole department for integrating the unit and the rest of the hospital routine. Preparing for the realization of the plan, the hospital administration should evaluate the potential benefits and losses, buy all the necessary equipment and pay attention to training of the staff.
Preparing an Evaluation Plan
The successful implementation of the CPU approach is not limited to buying all the necessary equipment and training the personnel. It is important to develop an evaluation plan, considering the most important components of organization of the work of the unit and assessing the effectiveness of the approach as compared to the traditional testing of the patients with acute chest pain at the emergency department (ED). The main criteria of the evaluation plan include the variation of the number of cases of misdiagnosing the patients with cardiac diseases, costs for monitoring of one patient, and clients’ satisfaction with the services.
Though the practice of introduction of CPUs in most sites has proven to be successful, the assessment of its effectiveness at a particular hospital setting is important for evaluating the benefits of the project or making some changes in it. Quin (2000) noted that “the available evidence suggests that chest pain evaluation units deliver what they promise, providing equivalent clinical outcomes to inpatient management, in a shorter time and for lower cost” (p. 406).
The comparative analysis of the number of adverse cardiac events among the patients who were discharged after testing at a CPU and those who were tested at a traditional ED is required for estimating the effectiveness of the approach and its impact on the patients’ outcome. Goodacre et al. (2005) noted that “The CPU aims to rapidly diagnose acute coronary syndrome (ACS), providing early access to appropriate care for those with positive test results and discharge home for those who test negative” (Which diagnostic tests are most useful).
The next step is comparison of the costs required for monitoring and diagnosing a patient at a CPU and using the traditional method, taking into consideration all the costs required for buying the equipment and training the staff. Blomkalns and Gibler (2005) noted that “a successful CPU also requires a nursing staff dedicated to the care of these patients with special needs” (p. 412).
The patients with acute undifferentiated chest pain require frequent testing, profound knowledge of the procedures and protocols. The issue of training the employees before start-up of the CPU should not be underestimated. The next assessment criterion is the patients’ satisfaction with the health care services and their attitude towards the innovative system. When the first CPUs were organized, the customers’ satisfaction increased.
However, the results of the recent studies contradict the data of the first surveys. Cross and Goodacre (2010) noted that “the ESCAPE study found no evidence that patient satisfaction was improved by the introduction of CPU and, if anything, the trend was towards reduced satisfaction” (p. 775). Though the customers’ satisfaction with the services may depend upon various factors, it remains a significant element of the evaluation plan of the CPU approach.
Conclusion
Evaluation of the effectiveness of the CPU approach to testing the patients with the acute chest pain is important for estimating the benefits and/or making changes in its organization. Number of adverse cases, the financial issue and customers’ satisfaction are the key components of the evaluation plan.
Reference List
Blomkalns, A. & Gibler, W. (2005). Chest pain unit concept: Rationale and diagnostic strategies. Cardiology Clinics, 23: 411-421. Web.
Cross, E. & Goodacre, S. (2010). Patient satisfaction with chest pain unit care: Findings from the Effectiveness and Safety of Chest Pain Assessment to Prevent Emergency Admissions (ESCAPE) cluster randomized trial. Emergency Medicine Journal, 27: 774-778.
Goodacre, S. et al. (2005). Which diagnostic tests are most useful in a chest pain unit protocol? BMC Emergency Medicine, 5 (6). Web.
Quin, G. (2000). Chest pain evaluation units. Western Journal of Medicine, 173(6): 403-407.