The role of nurses in a chest pain unit Kaat Siebens a, ⁎ , Philip Moons b , Sabina De Geest b,c , Hielko Miljoen a , Barbara J. Drew d , Christiaan Vrints a a Cardiology Department, University Hospital Antwerp, Edegem, Belgium b Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium c Institute for Nursing Science, University of Basel, Basel, Switzerland d Department of Physiological Nursing, School of Nursing, University of California, San Francisco, United States of America Received 6 November 2006; received in revised form 23 January 2007; accepted 29 January 2007 Available online 8 March 2007 Abstract The chest pain unit (CPU) provides a service for patients at moderate-to-low risk for acute coronary syndrome (ACS). Although the number of CPUs has continued to grow worldwide, little has been written on the specific role and contribution of nursing in CPUs. The stay of patients in the CPU can be divided into six stages: triage, diagnosis, treatment, observation/monitoring, discharge, and follow-up. CPU nurses are in a unique position to promote evidence-based practice during all of these stages. Deeper insight into the unique role of nurses in CPUs will promote understanding of what type of knowledge, skills, and attitudes are required to provide the services that will contribute to improved quality of care for chest pain patients. © 2007 European Society of Cardiology. Published by Elsevier B.V. All rights reserved. Keywords: Chest pain unit; Nursing; Acute coronary syndrome 1. Introduction Despite remarkable progress in the prevention and the treatment of ischemic heart disease, it remains the leading cause of death worldwide [1], accounting for over 1.95 million deaths in Europe each year [2]. The most common presenting symptom of myocardial ischemia is chest pain or discomfort [3]. Up to 7% of emergency department (ED) visits in the USA and Europe are patients presenting with chest pain [4–7]. About 10% to 15% of those patients are eventually diagnosed with an acute myocardial infarction (AMI) [8–10]. Acute coronary syndrome (ACS) is an umbrella term that encompasses all categories of patients with an unstable coronary atherosclerotic plaque requiring hospitalization and immediate treatment. The categories of ACS include ST elevation myocardial infarction (STEMI), non-STEMI, and unstable angina. In the last few decades, a fundamental change in health care delivery has occurred for patients with acute coronary syndrome (ACS). Medical–technical care has been developed and introduced to Coronary Care Units (CCU) [4], the first of which opened in 1961 [11]. Stimulated by the development of thrombolytic therapy and angioplasty, a paradigm shift from palliative care to early intervention occurred in the early 1980s. Through earlier intervention, physicians were able to mitigate, or even prevent, the progression of ACS [12]. Today, CCUs provide a high-tech, although extremely costly, environment for the diagnosis and treatment of ACS [12]. Unfortunately in the 1980s, CCUs became overcrowded with low-risk patients that were conservatively admitted to rule out AMI. Approximately 70% of patients admitted to CCUs did not develop an AMI during observation and were discharged after two to three days, with no significant disease being detected [4,9,12–14]. Ironically, while the CCUs were overcrowded, in EDs about 2% to 8% of chest pain patients suffering from an AMI were mistakenly sent European Journal of Cardiovascular Nursing 6 (2007) 265 – 272 www.elsevier.com/locate/ejcnurse ⁎ Corresponding author. Tel.: +32 3 821 45 75; fax: +32 3 825 08 48. E-mail address: kaat.siebens@uza.be (K. Siebens). 1474-5151/$ - see front matter © 2007 European Society of Cardiology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ejcnurse.2007.01.095