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Taking a closer look at using the Emergency Severity Index tool at emergency department triage for patients who present with suspected acute coronary syndrome

Stemler, Jennifer (2021) Taking a closer look at using the Emergency Severity Index tool at emergency department triage for patients who present with suspected acute coronary syndrome. Undergraduate Thesis, University of Pittsburgh. (Unpublished)

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Background: Emergency department (ED) nurses should rapidly identify potential patients with
acute coronary syndrome (ACS) because delays in care could impact patient outcomes.
Purpose: This study aims to describe the various ED resources utilized by patients with suspected
ACS and identify general characteristics of this population. Additionally, we evaluate associations
of utilization patterns and patient characteristics with assigned level of acuity at initial ED patient
nurse encounter.
Methods: This is a secondary analysis of a retrospective study of ED patients who were suspected
of having ACS presenting to one of 17 EDs in a large regional health care system. We used
descriptive analytics to investigate patient demographics, past medical and surgical histories, ED
resources, initial presenting vital signs, hospital admissions, and nurse assigned Emergency
Severity Index (ESI) levels. Univariate and multivariate linear regression was used to determine
associations between patient characteristics and resource utilization. Univariate and multivariate
binary logistical regression was used to determine associations of resources with assigned high
acuity ESI level and hospital admission.
Results: Our sample included 1196 patients (mean [SD] age 65 [14] years, 54% male, 89% white, and 1%
Hispanic). Of these, 522 (43%) patients had an in-hospital diagnosis of ACS. Systolic blood pressure was
the most commonly documented abnormal vital sign upon ED arrival. Overall hospital admission
DocuSign Envelope ID: 9F78E7CA-E93C-4168-946A-0FD204409984
rate was 72%. Chronic obstructive pulmonary disease showed a statistically significant association with
utilization of more ED resources. Patients used an average of 4.5 resources in the ED. Radiologic testing,
electrocardiogram done within 10 minutes of arrival, and complex procedures were associated with being
assigned high acuity ESI levels. The following ED resources were predictor variables and had an increased
likelihood of being admitted to the hospital: electrocardiogram done within 10 minutes, intravenous
medication administration, specialty consult, and laboratory testing.
Conclusion: Patients with suspected ACS on average use more resources and have a higher
admission rate compared to all ED patients. Nurses should consider patient characteristics,
abnormal vital signs and anticipated resource utilization in this subpopulation when assigning ESI
levels. Future work should focus on a larger cohort of patients with suspected ACS.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Stemler, JenniferJLS433@pitt.eduJLS4330000-0003-1063-9070
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee MemberDechant, Jasonjdec@pitt.edujdec
Committee ChairJordan,
Committee CoChairFrisch, Stephaniesof9@pitt.edusof9
Thesis AdvisorAl-Zaiti, Salahssa33@pitt.edussa33
Date: 23 April 2021
Date Type: Publication
Defense Date: 16 April 2021
Approval Date: 23 April 2021
Submission Date: 23 April 2021
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 62
Institution: University of Pittsburgh
Schools and Programs: University Honors College
School of Nursing > Nursing
Degree: BSN - Bachelor of Science in Nursing
Thesis Type: Undergraduate Thesis
Refereed: Yes
Uncontrolled Keywords: Emergency Department, Emergency Severity Index, Triage, Resources
Date Deposited: 23 Apr 2021 19:24
Last Modified: 23 Apr 2022 05:15


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