After evaluating patients’ experiences of and satisfaction with the various aspects of care for chest pain received from advanced nurse practitioners (APNs), researchers found that direct APN to APN referral provides patients with expert assessment and accelerated access to diagnostic testing, resulting in faster diagnosis, according to a study published in the Journal for Nurse Practitioners.

conducted a cross-sectional study of patients presenting to the emergency
department in Ireland with nonacute coronary syndrome chest pain. Patients were
evaluated by an APN at 2 hospital sites. Each APN-led chest pain clinic provided
patients with similar services; however, site A did not have a cardiology service.
Patients who were determined to require cardiology care were referred to site
B. All patients who were evaluated by an APN (N=117) were then provided with a
questionnaire to assess all aspects of APN-led chest pain services in both

A total of 62% of patients
(n=73; 60% men; mean age, 56 years) responded to the questionnaire. The
majority of respondents at site A (94%) expressed a preference to be seen by
the APN as opposed to a general practitioner or admitted to the hospital.
Similarly, 96% of all respondents did not mind attending the referral
appointment at site B, and 86% of all respondents were pleased to be evaluated
by the APN.

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A total of 96% of patients felt positively about the explanations they received from the APN regarding further testing for their condition, and 97% felt positively about access to further testing. A total of 56% of patients received a final diagnosis; of these patients, 78% rated the time it took to obtain this diagnosis as “very good” or “excellent.”

Patient satisfaction
levels with each aspect of the care pathway at both sites were recorded as good
to excellent, with perceived competence of the APN scoring highest. A minority
of patients indicated a response of poor to fair for waiting times (site A=10%;
site B=7%).

A total of 70% of
respondents felt that presenting to APN-led chest pain services prevented their
chest pain symptoms from worsening. The majority of participants (93%)
identified positive APN service benefits; emerging themes included the APN
approach, information and reassurance, service efficiencies, and access to the
tests required. A total of 22% of participants reported APN service
dissatisfaction with emerging themes of systems issues, waiting times, and

support for ANP role development is pivotal to the success of service initiative,
such as this one,” the authors stated. “[We] recommend that similar
outreach cardiology clinics are established and evaluated in other hospitals
where cardiology services are limited to ensure equitable access to all


O’Toole J, Ingram S, Kelly N, Quirke MB, Roberta A, O’Brien F. Patient satisfaction with innovative nurse practitioner cardiology services. J Nurs Pract. 2019;15(4):331-315.e1

This article originally appeared on Clinical Advisor