Using personal digital assistants and patient care algorithms to improve access to cardiac care best practices

Research design/methodology

TYPE: Non-Randomized, non-comparative pilot trial

VALIDITY: This pilot study has a limited design. Unfortunately, the paper did not report the demographic characteristics of the subjects. Furthermore, there is no control or comparative group for measuring observed differences.

ENVIRONMENT: A quaternary cardiac care hospital serving a post-treated population and attended by phone call.

Research question

Can a decision support tool (DST) on a personal digital assistant (PDA) for cardiac tele-triage/tele-consultation guide nurses in the assessment of chest pain in patients attended by phone call?

Patient/Problem/Population definition

PATIENT: Adult cardiac and cardiac surgical patient (age was not described nor the timeline of the cardiac condition)

PROBLEM: Assessment of chest pain for triage diagnosis.  Nurse assistance for the improvement of clinical diagnosis of initial chest pain.

POPULATION: Adult cardiac and cardiac surgical patients

Intervention

Assessment of chest pain diagnosis with the assistance of a DST (based on diagnostic algorithms) on PDAs (Palm Tungsten T3) for nurses during phone call consultations . The algorithms were reviewed and approved by the cardiac surgeon and cardiologist on the research team.

Comparison

No group was used for comparison. Furthermore, there was no assessment of the potential differences with the reported 25% of the phone calls where the nurses did not use the DST on PDA diagnostic approach.

Outcome

Over a 3-month period, participating nurses attended 61 chest pain calls, 75% of them were documented with the DST on PDA. The advice provided to the patient by the nurse was considered appropriate by the patient’s physician in 97% of the calls (this percentage was calculated with the total number of phone calls; it was not stated whether there were differences according to whether the DST on PDA was used or not); 92% of the patients reported satisfaction with the advice they received.

Application of results to patient care

DST on PDA may be a useful tool for improving the assessment of chest pain in cardiac patients, reducing the time for triage diagnosis and improving the clinical skills of the attending nurse.

Further areas for research

• Plan for larger trials, improve the research design, include a control group, include an appropriate statistical analysis and compare different DST designs.
• Assess the difference with other DSTs such as printed clinical guidelines and laptop and desktop diagnostic software.
• Test the applicability of these results in other clinical settings as well as in other cardiac patients including primary cardiac patients.