The role of the Advanced Clinical Practitioner (ACP) in triaging patients with Non ST-Elevation acute coronary syndromes (NSTE-ACS) patients for coronary angiographic procedures

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The introduction of the ACP role to a cardiology service with emphasis on measuring the effect of this role on improving the Inter-hospital transfer pathway for patients with ACS by improving patient outcomes ACPs triage a large number (estimated n = 2500 per year) of cardiology IHT referrals from these hospitals and ensure effective transfer to our centre for ACS treatment whilst supporting staff in the care of those patients who do not meet our transfer criteria or are acutely unwell for transfer but cardiovascular stable Patients are listed in order of presenting symptoms, presence or absence of chest pain on admission, relevant blood results such as infection markers, kidney function, and troponin a cardiac biomarkers, ECG findings, drug history , past medical history and arrival to hospital rather than clinical urgency . Purpose Therefore the purpose of this evaluation was to measure the patient outcomes of introduction of an ACP in triaging patients with NSTE-ACS)patients for coronary angiographic procedures. Methods Quantitative design approach with a specialist cardiology setting using a 2-year observational analysis of the data.The study population included all patients referred for angioplasty or PCI via the Inter-hospital transfer acute coronary syndrome network including all patients referred for PCI following NSTE-ACS. Results : There were a total of n= 4976 patients referred for coronary angiogram +/-proceed procedures between Feb 2018 and Feb 2020. Overall significant positive outcomes were noted across a consistent patient group based on presenting symptoms and patient characteristics when comparing data in the year preceding ACP led triage. A 2-sided p-value <0.05 defined statistical significance and to reject the null hypothesis. There was a significant reduction in waiting time post introduction of ACP led triage (p < 0.0001) equating to one day Comparison from pre ACP to post ACP led triage and clinical cancellation rates was reduced significantly (p = 0.0062). Rates of revascularisation were significantly higher post ACP led triage with a corresponding decrease in those managed medically (47.2% pre vs 43.1% post, p = 0.0037). These higher rates consisted of increased rates of both CABG (12.4% pre vs 13.5% post, p = 0.04) and PCI 40.4% vs 43.4%, p = 0.0216) Conclusion ACP led triage of ACS patients requiring urgent treatment demonstrates improved patient outcomes with economic benefits for healthcare providers, enhancing the service provided and opens up discussions for further quality improvement and implications to practice. Evidence of the benefits of advanced practice and the role of the advanced clinical practitioner is demonstrated within the cardiology setting and for the clinical triage of a patient group.