Severity of diagnosis among patients with chest pain presenting to the emergency department after calling a nurse line

Abstract

Background and objectives: A Nurse Line (NL) is a resource that is commonly used by patients and hospitals to assist in the triage of patient medical complaints. We sought to determine whether patients with chief complaint of chest pain who presented to the ED after calling a NL were different from patients who presented directly to the ED. The primary aim was to test for differences in the severity of the causes of chest pain between the two groups.

Methods: This was a retrospective case-control chart review study. Data collected included demographic data, comorbidities, ED orders, ED interventions, patient primary diagnosis and disposition.

Results: 350 patients were included in the analysis: 175 patients called the NL and 175 age/sex matched patients did not call the NL. The mean age was 58.3 (SD 16.4; range 19.1-93.3) and 53.7% of patients were female. Race was similar between the groups. Patients were more likely to go directly to the ED without calling a NL if they had comorbidities. Among the total cohort, 36 patients were deemed to have a serious diagnosis related to the pain; this did not differ between groups (16 NL, 20 non-NL; OR = 1.11 95%CI 0.55-2.23). There were no differences of ED work-up or hospital admission (50 NL, 67 non-NL; OR = 0.85 95%CI 0.51-1.42) between the groups.

Conclusion: NL call was not associated with differences in severity of diagnosis, work-up, hospital admission or patient demographics. Patients who presented to the ED with chest pain without calling a NL had more comorbidities.

Keywords: Chest pain; Diagnosis; Nurse line.