Poor communication hinders adequate treatment of acute chest pain

Early recognition and treatment are the key to survival in cases of acute chest pain. Clinical guidelines, both national and international, are used to ensure that the treatment is based on best practices; yet there is often a gap between the guidelines and practice.

The nurses felt they didn't get feedback when they had patients with diffuse symptoms, like back pain, difficulty of breathing and dizziness. This was when they felt a lack of collaboration with other health care providers.

Michael Ulrich Hansen

”Ambulance staff have many guidelines to follow, for everything from sepsis or strokes to hip fractures, but the guidelines for suspected heart attacks have the lowest adherence among ambulance nurses. We wanted to know why this is the case,” says Michael Ulrich Hansen, doctoral student in care science.

The Swedish study included interviews with 22 ambulance nurses, who were asked about their use of prehospital guidelines in their treatment of acute chest pain.

While the majority were familiar with the guidelines themselves, they felt insecure about the interpretation of symptoms and the assessment of treatment options, especially when it came to unspecific and diffuse symptoms. In these cases, using the guidelines as a tool was found challenging, and it led different colleagues to different conclusions.

Insufficient collaboration and lack of communication exacerbated the uncertainty. When treating chest pain, ambulance nurses need to send the patient’s medical history and ECG data to a cardiologist who provides their assessment.

”However, they did not always get responses with instructions on what to do. The nurses felt they didn't get feedback when they had patients with diffuse symptoms, like back pain, difficulty of breathing and dizziness. This was when they felt a lack of collaboration with other health care providers.”

The interview study is part of Ulrich Hansen's doctoral thesis, which runs until 2026. Data from this study will be used to develop an instrument to measure what might influence ambulance nurses’ adherence to guidelines.

”Our key conclusion from the interviews is that there is a need for better follow-up of ambulance nurses’ work. If they don't know what the patient’s condition is, they can't know if they made the right decisions or not,” he says.

Text: Anna Dahlbeck & Anna Jaakonaho