Before COVID-19, if a patient came to the emergency department with chest pain they would be assessed by an ANP/CNS. Once a heart attack was ruled out, the patient was discharged and invited to the nurse-led chest pain clinic to follow up for potential heart disease and a diagnostic test. The nurse-led chest pain service is a pioneering service at Tallaght University Hospital, Dublin that has been really successful in admission avoidance and diagnosing coronary heart disease.
Ireland has managed the pandemic very well and hospitals haven’t been overwhelmed, but we did see a huge reduction in the number of patients coming to hospital with chest pain. We’ve tackled this issue with social media and patient presentations to the ED with chest pain are rising, but now in the era of social distancing, there are no face-to-face clinics and very limited access to diagnostics for follow up.
Now, once a heart attack is ruled out, patients are electronically referred to me and I telephone them. I now assess the patient over the phone instead of face-to-face. I take their health history, risk profile, medications and perform risk stratification, all by a conversation. I decide if the diagnostic investigation is warranted or discharge to primary care. Capacity for diagnostic testing has been an issue, but it’s becoming more available now with COVID-19 precautions in place. I then follow up after the test telephoning the patient with the results.
Setting this tele-service up has meant a number of major changes. In particular, we had to enhance the nurse prescribing policy so that I can prescribe ‘virtually’. This means I can continue to operate autonomously. Prior to the pandemic, there were four nurses (2ANP/2CNS) in the chest pain service but redeployment to critical care areas means it’s currently just me! However, I work in close collaboration with consultant cardiologist Dr. David Moore, emergency department Consultant Dr Aileen Mc Cabe and ED colleagues, physiologists and my amazing administration colleagues. Running services virtually is a totally different logistic and relies hugely on administration support, often overlooked.
Patients really appreciate the phone call and the follow-up, they find it reassuring. Although the process is more time-consuming than the face-to-face service it’s vital for the safe discharge of the patient with non-ACS chest pain from ED.
Picture: Shirley is in the centre, Dr Aileen McCab (ED) to the left, Dr Mohammad Tariq to the right.