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Nursing faculty strive to develop nurses who are culturally aware and sensitive in an effort to value equal treatment for all persons. Unfortunately, these values may not be reflected in triage strategies used to evaluate persons presenting to emergency rooms with complaints of chest pain. Dr Lenny Lopez, Morgan Institute for Health Policy at Massachusetts General Hospital, reports differences in triage categorization and cardiac tests ordered for emergency room patients associated with race, sex, and insurance coverage.


The American College of Cardiology and the American Heart Association provide standing guidelines stating that all patients presenting to an emergency room with complaints of chest pain should immediately receive an electrocardiogram. Lopez and his team retrospectively evaluated data collected between 1997 and 2006. The researchers looked at demographic and treatment information for 22,000 patients reporting to emergency rooms in the United States with complaints of chest pain, tightness, or burning.


Data analysis showed that Hispanics and blacks were less likely than whites to undergo an electrocardiogram. In addition, these same demographic groups had fewer orders for monitoring heart function and heart enzyme levels. The investigators also found that medicated and uninsured patients were less likely to be handled according to standard protocols. During triage, these patients do not seem to be targeted for immediate urgent care, but are deemed by triage personnel to be able to wait in the emergency room for treatment. Lopez notes that "Emergency room triage is the critical step that determines the whole cascade of clinical decisions and testing that happens next." If patients are inappropriately triaged, all subsequent tests and treatments are altered.


This information is unfortunate. However, with this evidence, nurse educators can continue to emphasize the core values of nursing and encourage our students to reflect these values in practice.


Source: Mozes A. Not all chest pain treated equally in U.S. hospitals: study. HealthDay: News for Healthier Living. September 29, 2010. Available at Accessed November 1, 2010.


Submitted by: Robin E. Pattillo, PhD, RN, CNL, News Editor at