NONPF 40th Annual Meeting
A Nurse Practitioner Managed Chest Pain Unit in a Rural Hospital
Background: One of the most frequent causes of presentation to an emergency department is acute chest pain. A rural community hospital in Kansas lost greater than $ 300,000 dollars in the fiscal year of 2011 related to the inpatient care of patients with chest pain. The care of these patients was also provider specific and not based on the best recent evidence in the literature. Chest pain units have been found to provide cost-effective care while improving patient outcomes by the utilization of a protocol driven system of care.
Purpose: The purpose of this project was to determine whether a nurse practitioner managed chest pain unit in a rural hospital would provide a system of care that was cost-effective, based on evidence-based practice compared with inpatient care.
Design: A retrospective chart review was used that evaluated the cost-effectiveness and evidence-based practice of chest pain unit care versus inpatient care of patients with acute chest pain. The complete electronic records of 400 patients (n = 200 participants [chest pain unit care] and n = 200 controls [inpatient care]), aged > 21 years, with acute chest pain were reviewed. Independent t-tests or cross tabulation procedures with Pearson’s Chi-Square were conducted to determine the equivalency between chest pain unit and control group. Following this, the dependent outcome variables were assessed for normality via their skewness and kurtosis indices. Thereafter, multiple regression procedures were conducted to test the relationship between the type of unit and the dependent outcome variables.
Outcomes: This study evaluated the cost effectiveness by total costs, percent of patients converted to inpatient status, and length of stay, and evidence-based practice by 30-day readmission, mortality, and adverse cardiovascular event rates of chest pain unit care versus inpatient care at a rural hospital.
Implications for Practice: Rural small hospitals provide cardiac care to underserved populations. This quality improvement and evidence-based project improved the financial health of this rural hospital and positively affected the cardiovascular outcomes of this patient population.