Improving emergency department throughput through a standing order for patients with chest pain as chief complaint

Background: When EDs function beyond their capacity, patients with chest pain do not receive needed time sensitive care. As a method to meet chest pain patients’ care needs and improve ED benchmark times, standing order sets have been implemented in EDs by nurses in triage.Methods: This project is a retrospective review of a quality improvement project. The DNP project was based in a small community hospital ED. All adult chest pain patients over 20 received a tro-ponin with their initial ECG as the order set, activated in a revised workflow. Results: ED throughput times changed significantly. A total of 208 patient charts were analyzed pre and postimplementation. Preintervention, time in minutes from ED arrival to ED discharge was 286 minutes; after implementation this was reduced to 229 minutes (Z = -2.256, p = .024). Time in minutes from arrival to troponin result pre-intervention was 135 minutes; reduced to 98 minutes in post-implementation (Z = -6.262, p = < .0001). Time in minutes from arrival to troponin order pre-intervention was 64 minutes; after the intervention, this was reduced to 23 minutes (Z = -7.809, p = < .0001). Time in minutes from arrival to ECG pre-intervention was 43 minutes; this was re-duced to 13 minutes (Z = -4.582, p = < .0001). Implications: The standing orders allowed for immediate assessment and treatment of chest pain patients which yielded quicker results and better patient outcomes. Recommendations to the site include implementing the full standing order set and maintain processes piloted in the project. Keywords: chest pain, troponin, electrocardiogram (EKG).D.N.P.Includes bibliographical reference