Ambulatory Care Pathway
Algorithm page
Ambulatory Care Pathway
Algorithm: Chest Pain (IHD)
Queen’s dect: 6090, 6908 or 6865
KGH bleep: 8408 or 8559
Clinical history and
examination suggestive
of ACS? *
New Onset Chest Pain,
(Angina highly likely)
*Important Information
Inpatient management
protocols for ACS
Yes
No
ACS defined as NSTEMI, STEMI or Unstable
Angina. The RACPC isn’t a service for all chest pains
or to facilitate quick discharge. There are OPD
services and ‘Hot Clinics’ which may be more
suitable.
Clinical history
suggestive of stable
angina? See page 2
No
Rapid Access Chest Pain
Clinic
Yes
Consultants can refer patients to the
chest pain clinic via ambulatory care
who exhibit new onset chest pain where
stable angina is suspected
Ambulatory Care Working Hours
Mon to Fri
Saturday
Sunday
BH
1. Potential compliance issues: eg.
Psychological, alcohol, drug abuse,
comprehension
2. Functionally unsafe at home
3. Dementia
4. Pregnancy / children
5. Patient outside local PCT’s
KGH
8am - 4pm
No service
No service
8am - noon
1. Attach any investigation requests to Ambulatory referral
form
BH
2. Complete ambulatory referral form plus RACPC referral
8am til noon
form and leave in deposit box
3. Contact ambulatory care nurse via phone
4. Please provide patient advice sheet (print from intranet)
5. Patient can be discharged from acute area including ED,
Rx Aspirin 75mg if no contraindication + GTN PRN
6. Home same day
No
Exclusion criteria
Pathway specific
Meets
exclusion
criteria?
1. Male <30, Female <40.
2. If a management plan has already been
agreed
3. Known to have IHD or have been
investigated within 5 years, please refer back
to their Consultant/GP
4. Symptoms other than chest pain as
presentation for possible IHD
GP
Queen’s
8am - 8pm
8am - 4pm
8am - 4pm
8am - 4pm
Refer to Ambulatory Care
Sunday
Working hours
referral
Closed
Exclusion criteria
General
Referral via:
Alternative causes such
as PE, pericarditis, GI
bleed may be managed
by appropriate medical
team. This also applies
to chest pain previously
known to cardiology
team.
YES
Out of hours and weekend referral
1. Attach any investigation requests to Ambulatory referral
form
2. . Complete ambulatory referral form plus RACPC referral
form and leave in deposit box
3. Please provide patient advice sheet (print from intranet)
4. Patient can be discharged from acute area including ED,
Rx Aspirin 75mg if no contraindication + GTN PRN
5. We will arrange Rapid access chest pain clinic follow-up
6. Home same day
Yes
Not for Rapid access chest
pain clinic.
Refer to appropriate
consultant, cardiac OPD or
Hot clinic service
ED
YES
GPU/ERU
YES
Chief Executive: Averil Dongworth
SAU/MAU/CAU
YES
In-patient
YES
Ambulatory Care Pathway
Important information page
Ambulatory Care Pathway
Important information: Chest Pain (IHD)
IMPORTANT: Referrals will only be accepted to the Ambulatory Care Service once a Consultant has reviewed the
patient and authorised referral, this must also be put on the referral form. Please attach any relevant tests.
Completing the ambulatory care referral form
It is essential that you fully complete the ambulatory care referral form (orange form) with specific attention to referring consultant
name and contact number. Fill in a RACPC Referral form, attach it to the orange form with an ECG copy and place them in deposit
areas (see below).
Deposit boxes for ambulatory referral form
Look out for deposit boxes at Queen’s MAU A and B and ED majors’ nurses’ station.
At KGH you will find the deposit boxes in CAU front desk and in ED majors’ nurses’ station.
If referral form is from another area of hospital then please try to deposit ambulatory care referral form in areas already stated. If you
are unable to deposit the form then call the ambulatory care nurse in working hours and they will collect.
DO NOT LEAVE THE ORIGINAL AMBULATORY REFERRAL FORM IN THE NOTES.
Pathway specific information
Rapid Access Chest Pain Clinic Purpose
The RACPC was established in line with the NSF Framework for CHD. Consultants can refer patients to the chest pain clinic via the
ambulatory care pathway when stable angina is suspected.
The RACPC is not to be used for referring patients for exercise tolerance testing/MPS nor should you recommend to the GP they refer
to the RACPC for one. If your clinical opinion is they require such a test you must independently refer for this. Please be advised of
the current NICE guidelines on the management of suspected IHD chest pain and that the role of exercise testing is limited. Patients
must NOT be told they will have or expect and ETT on the day. Please discuss any difficult or out of protocol cases you may have
with the CNS (Cardiac Nurse Specialist)
Clinical guidelines for referral
Precipitating factor
Position on chest
Type of pain
Duration of pain
Chest Pain Score
Always on exertion, relieved by rest
Emotional stress/exposure to cold/after meal
Nothing in particular/unpredictable
Breathing in/out
Front of chest/neck/shoulders/jaw/arms/epigastric
Right-side/sub-mammary/very localised
Constricting/cramping/heavy/tight/burning/dull ache
Stabbing/sharp
Reproducible by manual pressure on chest wall
< 15 minutes
Few seconds only
> 15 minutes to hours
3
1
0
-1
1
0
1
0
-1
1
0
-1
Total Chest Pain Score
_____
If score is 3 or more Typical stable angina – REFER
If score is 2
Possible atypical angina - if ≥1 risk factors listed below, REFER
If score is ≤ 1
Unlikely to be stable angina – consider alternative cause, DO NOT REFER
Ambulatory Care Team
Ambulatory Care Nurses at Queen’s
Cathy Dunne
Sharon Hayes
Christine Burnett
Herbert Chakawa
Susan Seth
Ambulatory Care Nurses at KGH
Elizabeth Obisesan
Lana Savitskaira
RACPC
Stuart Wright
Fouad Magho
Matron
Senior Sister
Sister
Charge Nurse
Staff Nurse
Queen’s 01708 435 000 DECT 6090, 6908, 6865
Senior Sister
Sister
KGH 02089 838 000 bleep 8408 ext. 5715
KGH 02089 838 000 bleep 8559 ext. 5715
Cardiac Nurse Specialist Queen’s 01708 435 000 DECT 6187 or Ext 3097
Cardiac Nurse Specialist Queen’s 01708 435 000 Ext 3608
Protocol development
This protocol is based on findings published by the European Society of Cardiology, NICE guidelines and expert review
Developed as Ambulatory Care pathway. Pathway leads :Dr Aram Salehi and Dr Gurvinder Rull.
Revision 1.7. Revision date 25 September 2013. Next planned review date 25 September 2014