Utilizing the Marburg Heart Score for Early Recognition of Chest Pain in an Urgent Care Clinic: A Quality Improvement Project
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Background/Problem: A challenging and concerning complaint presenting to any health care practice is chest pain. Chest pain is a ubiquitous complaint that accounts for 8-10 million emergency department visits and 1% to 3% of all primary care visits in North America annually. Urgent care clinics provide another option for patients seeking care for chest pain. However, there is currently no standardized protocol or uniformed practice recommendations for urgent care facilities to care for chest pain complaints. This void can create a barrier to prompt recognition and appropriate triage decision of chest pain in an urgent care clinic. Purpose: To develop and implement an evidence-based protocol for promptly recognizing and triaging a patient in an urgent care clinic over an 8-week period. Methods: The population for this project was patients over the age of 18 years presenting to an urban Midwest urgent care clinic with chest pain complaints. A clinical form and checklist were developed to assist in determining a level of risk to promptly aid nurses and providers in next steps such as waiting their turn in lobby, triaging them back to exam room with electrocardiogram, and/or sending them to the emergency department. Clinic registered nurses received education regarding the use of the protocol and involvement of the healthcare providers’ instruction and feedback. Findings/Results: A total of 18 patients with chest pain completed the scoring form; of those, six patients were sent to the emergency department via private car or ambulance. The final data showed positive feedback as well as early recognition of an acute coronary emergency. There was a statistically significant difference in the wait times when comparing pre-intervention and post-intervention data. Implications for Practice: Potential benefits include a timelier decision-making process due to earlier recognition of what needs to be triaged and sent to the emergency department. Patients benefit from a consistent, standardized, and punctual procedure used by providers and staff to assist in early recognition of a cardiovascular emergency versus a stable, intermittent chest pain that can be managed in urgent care.
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