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COURSE DETAILS
Course Code: NURS1005 Course Name: Cardiovascular Health
Course Coordinator: Angelique OBrien Your Word Count: 502

STUDENT CONTACT DETAILS
Student Number: 43520877 Student Name: Stephanie Harris
Address: 125 Thornton Street
RACEVIEW QLD 4305
Email address: sharr124@gmail.com
Telephone: (07) 3288 6304

Mobile: 0432 877 995

STUDENT DECLARATION

TO ACCOMPANY INDIVIDUAL STUDENT ASSIGNMENT

I declare that I have read the UQ Academic Integrity and Plagiarism policy including the approved use of plagiarism
detection software, the consequences of plagiarism and the principles associated with preventing plagiarism. *
(http://www.uq.edu.au/hupp/index.html?page=25128)

I declare that the material contained in this assignment is my own work and that where I have used the ideas or writing of
other authors that this has been acknowledged according to accepted academic guidelines.

I further declare that the material contained in this assignment has not been submitted in whole or substantial part, to
meet the assessment requirement in another course at this, or any other, university.

I have kept a copy of this assignment.

* Work submitted will be subjected to a plagiarism detection process. When this process is used, copies of this work would be retained
and used as source material for conducting future plagiarism checks.

Signed: Stephanie Harris Date: 04/08/2014
Due Date: 07/08/2014 Submitted date: 06/08/2014
Extension Applied For: Yes No Revised Due Date:

** typing in your name on this declaration will perform as your signature for electronic communication

Faculty of Health Sciences
SCHOOL OF NURSING & MIDWIFERY
ASSIGNMENT COVER SHEET


Assignment Mark
(Markers use only)
Synopsis 1: Australian Triage & ED 43520877
NURS1005 Cardiovascular Health 2

Introduced into Australian hospitals some time during the 1970s, triage is defined in
Merriam-Webster as the assignment of degrees of urgency to wounds or illnesses to
decide the order of treatment of a large number of patients or casualties (Merriam-
Webster Online, n.d.). Known today as the Australasian Triage Scale (ATS), five
categories outlining descending levels of clinical urgency are used to facilitate
prioritised yet equitable access to emergency health care services (Health Policies
Priorities Principal Committee, 2011). This synopsis will briefly explore the Australian
triage protocols, the service delivery performance of national hospital emergency
departments, and how their performance affects the outcomes of patients presenting to
the ED with chest pain.
The first category within the ATS indicates a critical life-threatening condition,
requiring immediate simultaneous assessment and treatment, including incidences of
cardiac and respiratory arrest. Category two signifies time-critical conditions or
presentation of severe pain, with assessment and treatment necessary within ten
minutes. The third and fourth categories represent potentially life-threatening
conditions to be assessed within thirty minutes and potentially serious conditions to be
assessed within sixty minutes respectively, and the assessment of situational urgency is
essential in both cases. Minor symptoms and non-urgent conditions epitomise the fifth
and final category (Australasian College for Emergency Medicine, 2013).
Regardless of its prestige within the medical profession and frequent systematic
reviews since its establishment in Australian hospitals, the triage system has not
completely eradicated the myriad challenges facing emergency departments (ED) and
service delivery. Increasing demand, limited capacity and lengthy waiting times still
plague hospitals on a national scale (Australasian College for Emergency Medicine,
Synopsis 1: Australian Triage & ED 43520877
NURS1005 Cardiovascular Health 3

2013), despite a 13.7% average increase in the percentage of patients departing within
four hours from major metropolitan Queensland hospitals between 2012-13 (National
Health Performance Authority, 2014).
Between 20072008 in Australia, there were 95000 hospitalisations for acute coronary
syndrome (ACS), which encompasses unstable angina pectoris, non-ST elevation
myocardial infarctions (NSTEMI), and ST segment elevation myocardial infarctions
(STEMI) (Handrinos, Braitberg & Mosley, 2014).
A cohort study by Loten et al. (2014) illustrated that 1819 of 2627 patients presenting
with chest pain to a large Australian emergency department were discharged without a
diagnosis of ACS after assessment following triage. A follow up with the discharged
patients 30 days after presentation revealed that 36 had either been re-diagnosed with
ACS, or suffered an acute coronary event such as unstable angina or NSTEMI. Nationally,
missed acute coronary diagnoses in emergency departments is estimated to stand at
approximately 3.5%, with patients in this category facing considerable rates of
morbidity and mortality (Cullen et al., 2013).
The majority of available emergency department research in relation to ACS places
emphasis on the prevention of inaccurate diagnoses resulting in poor patient outcomes,
however in some cases, this directly corresponds with poor utilisation of hospital time,
resources and funding, increased staff workload, and exposure of patients to the risks of
nosocomial infections due to unnecessary hospital admission. Further research and
review of current and international guidelines undeniably hold the key to continual
improvement in the efficiency of this service delivery.

Synopsis 1: Australian Triage & ED 43520877
NURS1005 Cardiovascular Health 4

REFERENCES

Australasian College for Emergency Medicine. (2013). Guidelines on the Implementation
of the ATS in Emergency Departments. (Document No. G24). Retrieved August 4, 2014, from
https://www.acem.org.au/getattachment/d19d5ad3-e1f4-4e4f-bf83-7e09cae27d76/G24-
Implementation-of-the-Australasian-Triage-Scal.aspx
Cullen, L., Greenslade, J., Hammett, C.J., Brown, A.F., Chew, D.P., Bileskya, J., Than, M.,
Lamanna, A., Ryan, K., Chu, K., & Parsonage, W.A. (2012). Comparison of Three Risk
Stratification Rules for Predicting Patients With Acute Coronary Syndrome Presenting to an
Australian Emergency Department. Heart, Lung and Circulation, 22(10), 844-851. doi:
10.1016/j.hlc.2013.03.074
Handrinos, A., Braitberg, H., & Mosley, I.T. (2014). Acute coronary syndrome diagnosis at
hospital discharge: How often do we get it right in the emergency department? Emergency
Medicine Australasia, 26(2), 153-157. doi: 10.1111/1742-6723.12165

Health Policies Priorities Principal Committee. (2011). Australian Triage Process Review
Project. Retrieved 4 August, 2014, from
http://www.ecinsw.com.au/sites/default/files/field/file/Australian%20Triage%20Process%2
0Review.pdf
Loten, C., Isbister, G., Jamcotchian, M., Hullick, C., MacElduff, P., Attia, J., & Marley, J.
(2014). Adverse outcomes following emergency department discharge of patients with possible
acute coronary syndrome. Emergency Medicine Australasia, 21(6), 455-464. doi:
10.1111/j.1742-6723.2009.01229.x

National Health Performance Authority. (2014). City emergency departments show big
improvements, regionals remain steady. Retrieved August 4, 2014, from
http://www.myhospitals.gov.au/Content/Reports/time-in-emergency-department/2014-
05/pdf/MyHospitalsUpdate_TimeInEd_Media_Release_May_2014.pdf
Queensland Health. (2013). Emergency Departments. Retrieved August 4, 2014, from
http://www.health.qld.gov.au/emergency/
Triage [Def. 1b]. (n.d.). Merriam-Webster Online. In Merriam-Webster. Retrieved August
4, 2014, from http://www.merriam-webster.com/dictionary/triage