Mary Grace Reyes

Project Site: Advocate Illinois Masonic Medical Center (AIMMC) Emergency Department (ED)

Faculty Advisor: Marilyn A. Prasun, PhD, CCNS, CNL, CHFN, FAHA, FAAHFN - Carle BroMenn Endowed Professor

Dissemination of Findings:

2025 Illinois State University (ISU) Research Symposium
2025 ISU Mennonite College of Nursing (MCN) DNP Intensives
Bi-Monthly Advocate Medical Group (AMG) North Clark/AIMMC Cardiology Faculty Meeting
Monthly AIMMC ED Providers and Advanced Practice Clinicians’ Education
Bi-Monthly ED-Chest Pain Fast Track Subcommittee Meeting
2025 ISU MCN DNP Orientation
2025 Advocate Health Nursing Virtual Conference

Manuscript Submitted to Journal of Nursing Care Quality, pending review

Introduction

Approximately 11 million emergency department (ED) encounters are attributed to chest pain (CP) annually (Cairns & Kang, 2022). Despite advances in cardiac and emergency care, CP remains to be one of the top reasons for ED visits. Yearly healthcare costs associated with CP are estimated to reach $108 billion (Haidar et al., 2025).

Local Problem

Patients presenting with CP comprise the highest number of observation admissions (OBS) in an urban, level 1 Trauma center in the Midwest. This ED sees an average of 2,530 CP cases annually (Advocate Health [AH], 2024). Patients had 29-hour average length of stay (LOS) because of challenges with scheduling timely cardiology and imaging appointments.

The ED providers use the HEART (history, electrocardiogram [ECG], age, risk factors, troponin) score to risk stratify and manage CP patients. The HEART score is an integral part of the CP pathway. However, the current pathway is not reflective of evidence-based practice. Thus, there are variabilities in managing these patients.

Methods

A plan-do-study-act (PDSA) approach was utilized for this initiative. A pre- and post-education survey was administered among ED nurses. Individual charts were audited to assess if project interventions resulted in improved patient outcomes. Patients who met inclusion criteria were 613 for the pre-intervention cohort and 697 for the intervention group. Interventions included educating ED nurses and implementing the CP pathway.

Findings

Twenty-two ED nurses completed the pre/post-education surveys and attended an education session. Their HEART knowledge significantly increased post-education, χ2(1) = 6.125, p = .008. Post-intervention HEART score compliance among ED providers increased to 81.4% from 71.7% (AH, 2025). Delayed intervention implementation may have influenced the increase in OBS and LOS post-intervention. In addition, ED discharges increased by 2.12% from 68.8% to 71.4%. If sustained, a yearly variable cost savings of approximately $85,536.54 is projected.

Practice Implications

Triage and ED nurses greatly influence the care of patients presenting with CP during their initial ED visit and beyond. Their prompt and thorough assessment during Triage encounters sets the tone on proper risk stratification and management of patients. The nurses’ close partnership with ED providers expedites disposition decisions, greatly influencing OBS, LOS, and associated costs. Through interdisciplinary collaboration, ED nurses facilitate continuity of care by ensuring that CP patients have cardiology appointments post-ED discharge. Implementing the CP initiative attests to the indelible influence nurses have in the provision of quality care across different care settings.

References

Advocate Health (AH). (2024, June 7). ED_10135 heart score utilization rate by ED providers. [Unpublished internal report].

Advocate Health (AH). (2025, May 1). 2025 Q1 patient detail for ED chest pain. [Unpublished internal report].

Cairns, C., & Kang, K. (2022, April 7). National hospital ambulatory medical care survey: 2019 emergency department summary tables. Centers for Disease Control and Prevention. https://stacks.cdc.gov/view/cdc/115748/.

Haidar, A., Gajjar, A., Parikh, R. V., Benharash, P., Fonarow, G. C., Watson, K., Needleman, J., & Ziaeian, B. (2025). National costs for cardiovascular-related hospitalizations and inpatient procedures in the United States, 2016 to 2021. The American Journal of Cardiology, 234, 63-70. https://doi.org/10.1016/j.amjcard.2024.10.003.