Improving the timeliness of care within emergency departments

Case Study Submitted by: Shirley Ingram
Country: Ireland

Tallaght Hospital has the largest Emergency Department (ED) in Ireland, with 48,000 adult attendances per year. There is high-level use of ED use by residents in the direct catchment; with 40% of household’s surveyed utilising adult ED in the previous 12 months. Chest pain is a principal presenting symptom of coronary heart disease and rose from 5% of all ED presentations to Tallaght Hospital in 2017 to 11% (4000 patients) in 2017. These growth levels have continued as expected with an ageing demographic in Tallaght.

48% of all chest pain presentations were admitted often remaining on a trolley in the ED for days whilst awaiting an in-patient bed. This presented a real problem in sustained emergency access pressures, growing trolley numbers and admitted bed days. Tallaght is a low socio-economic area in southwest Dublin with a high level of cardiac risk factors such as smoking and obesity. The Tallaght Hospital ED is one of the busiest in the country.

 The Cardiology Advanced Nurse Practitioner led Chest Pain Service has delivered remarkable patient benefits in the last three years with limited resource investment including the avoidance of almost 600 inpatient admissions per year.

The overall aim of this innovative service is to discharge appropriate patients from the ED to the nurse-led chest pain clinic for further assessment and testing. This provides a safe, competent service to the patient whilst avoiding admission.

Within the first-year of the Cardiology Advanced Nurse Practitioner led Chest Pain Service admissions to the ward reduced by 36%, and to ED trolleys by 60%, contributing to significant savings for the hospital. Patients also receive a timely diagnosis, health promotion and reassurance.



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