Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 3, Number 1, February 2012, pages 8-15

New Guidelines for the Management of Chest Pain: Lessons From a Recent Audit in Tauranga, New Zealand

Figure 1. This bar graph highlights the time to initial ECG within the emergency department, versus the total number of completed ECGs. The College of Emergency medicine target of 90% ECG completion within 10 minutes is shown in black.

Figure 2. This bar graph depicts time to administration of pain relief after admission, versus the total percentage of patients requiring pain relief. The College of Emergency medicine targets of 75% pain relief within 30 minutes, and 90% within an hour, are shown in black.

Figure 3. This bar graph depicts time to aspirin prescription from admission. The College of Emergency Medicine target of 90% prescription to those eligible is highlighted in black.

**Table 1.** Adapted From NICE Guideline 95 [5]
Summary of NICE Guidance regarding management of acute chest pain presentations
Take a resting 12-lead ECG as soon as possible. When a patient is referred, send the results prior to arrival provided this does not delay transfer.
Do not exclude an acute coronary syndrome (ACS) when patients have a normal resting 12-lead ECG.
Do not routinely administer oxygen. Monitor oxygen saturation using pulse oximetry as soon as possible, ideally pre-admission.
Only offer supplementary oxygen to:
-People with SpO₂ <94% who are not at risk of hypercapnic respiratory failure, with a target SpO₂ of 94-98%
-People with chronic obstructive pulmonary disease who are at risk of hypercapnic respiratory failure, with a target SpO₂ of 88-92%, until blood gas available.

Table 1. Adapted From NICE Guideline 95 [5]

Summary of NICE Guidance regarding management of acute chest pain presentations

Take a resting 12-lead ECG as soon as possible. When a patient is referred, send the results prior to arrival provided this does not delay transfer.

Do not exclude an acute coronary syndrome (ACS) when patients have a normal resting 12-lead ECG.

Do not routinely administer oxygen. Monitor oxygen saturation using pulse oximetry as soon as possible, ideally pre-admission.

Only offer supplementary oxygen to:

-People with SpO₂ <94% who are not at risk of hypercapnic respiratory failure, with a target SpO₂ of 94-98%

-People with chronic obstructive pulmonary disease who are at risk of hypercapnic respiratory failure, with a target SpO₂ of 88-92%, until blood gas available.

**Table 2.** Results Comparing Tauranga Hospital to NICE Standard
	Tauranga Hospital % concordance and (number/all eligible)
All aspects investigated correlate to NICE guideline 95, and established concordance targets are 100%.
Initial Assessment
Current Pain Status	100%
Time of Onset	100%
Resting ECG	99.2% (117/118)
Pain relief (if required)	91.3% (74/81)
Aspirin (if not allergic)	78.7% (74/94)
Appropriate O₂ usage	54.4% (31/57)
Cardiac Marker tested	97.5% (115/118)
Monitoring
Pulse oximetry	98.3% (116/118)
Pulse	99.2% (117/118)
Blood Pressure	100%
Pain	94% (111/118)
Repeat ECG	59.3% (70/118)
Telemetry	57.6% (68/118)
Further Assessment
Pain Characteristics	100%
Associated symptoms	93.2% (110/118)
Cardiovascular History	98.3% (116/118)
Risk Factors	77.1% (91/118)
Previous Episodes	100%
Full Examination	100%

Table 2. Results Comparing Tauranga Hospital to NICE Standard

Tauranga Hospital % concordance and (number/all eligible)

All aspects investigated correlate to NICE guideline 95, and established concordance targets are 100%.

Initial Assessment

Current Pain Status

100%

Time of Onset

100%

Resting ECG

99.2% (117/118)

Pain relief (if required)

91.3% (74/81)

Aspirin (if not allergic)

78.7% (74/94)

Appropriate O₂ usage

54.4% (31/57)

Cardiac Marker tested

97.5% (115/118)

Monitoring

Pulse oximetry

98.3% (116/118)

Pulse

99.2% (117/118)

Blood Pressure

100%

Pain

94% (111/118)

Repeat ECG

59.3% (70/118)

Telemetry

57.6% (68/118)

Further Assessment

Pain Characteristics

100%

Associated symptoms

93.2% (110/118)

Cardiovascular History

98.3% (116/118)

Risk Factors

77.1% (91/118)

Previous Episodes

100%

Full Examination

100%

**Table 3.** Highlights Investigation of Time of Admission as a Potential Influence on the Management of Patients With Chest Pain
		P value
† investigated with Mann Whitney U-Test; ‡ investigated with Fisher’s exact test for contingency tables; denotes statistical significance at the 10% confidence level;*denotes statistical significance at the 5% confidence level.
Time of Admission	Time to ECG †	0.784
	Time to Pain Relief †	0.342
	Time to Venepuncture †	0.783
	Pain Monitoring ‡	0.352
	Telemetry ‡	0.177
	Repeat ECG ‡	0.039**

Patient Age	Aspirin use	0.067*

Table 3. Highlights Investigation of Time of Admission as a Potential Influence on the Management of Patients With Chest Pain

P value

† investigated with Mann Whitney U-Test; ‡ investigated with Fisher’s exact test for contingency tables; *denotes statistical significance at the 10% confidence level;**denotes statistical significance at the 5% confidence level.

Time of Admission

Time to ECG †

0.784

Time to Pain Relief †

0.342

Time to Venepuncture †

0.783

Pain Monitoring ‡

0.352

Telemetry ‡

0.177

Repeat ECG ‡

0.039**

Patient Age

Aspirin use

0.067*