After evaluating patients’ experiences of and satisfaction with the various aspects of care for chest pain received from advanced nurse practitioners (APNs), researchers found that direct APN to APN referral provides patients with expert assessment and accelerated access to diagnostic testing, resulting in faster diagnosis, according to a study published in the Journal for Nurse Practitioners.
Researchers conducted a cross-sectional study of patients presenting to the emergency department in Ireland with nonacute coronary syndrome chest pain. Patients were evaluated by an APN at 2 hospital sites. Each APN-led chest pain clinic provided patients with similar services; however, site A did not have a cardiology service. Patients who were determined to require cardiology care were referred to site B. All patients who were evaluated by an APN (N=117) were then provided with a questionnaire to assess all aspects of APN-led chest pain services in both sites.
A total of 62% of patients (n=73; 60% men; mean age, 56 years) responded to the questionnaire. The majority of respondents at site A (94%) expressed a preference to be seen by the APN as opposed to a general practitioner or admitted to the hospital. Similarly, 96% of all respondents did not mind attending the referral appointment at site B, and 86% of all respondents were pleased to be evaluated by the APN.
A total of 96% of patients felt positively about the explanations they received from the APN regarding further testing for their condition, and 97% felt positively about access to further testing. A total of 56% of patients received a final diagnosis; of these patients, 78% rated the time it took to obtain this diagnosis as “very good” or “excellent.”
Patient satisfaction levels with each aspect of the care pathway at both sites were recorded as good to excellent, with perceived competence of the APN scoring highest. A minority of patients indicated a response of poor to fair for waiting times (site A=10%; site B=7%).
A total of 70% of respondents felt that presenting to APN-led chest pain services prevented their chest pain symptoms from worsening. The majority of participants (93%) identified positive APN service benefits; emerging themes included the APN approach, information and reassurance, service efficiencies, and access to the tests required. A total of 22% of participants reported APN service dissatisfaction with emerging themes of systems issues, waiting times, and treatment/care.
“Organizational support for ANP role development is pivotal to the success of service initiative, such as this one,” the authors stated. “[We] recommend that similar outreach cardiology clinics are established and evaluated in other hospitals where cardiology services are limited to ensure equitable access to all patients.”
O’Toole J, Ingram S, Kelly N, Quirke MB, Roberta A, O’Brien F. Patient satisfaction with innovative nurse practitioner cardiology services. J Nurs Pract. 2019;15(4):331-315.e1