Nurse led detection of adverse events following cardiac admissions and procedures in a regional Australian health district

Background: Heart disease is the number one cause of death in the world. Heart disease results in a significant number of hospitalisations, diagnostic testing, and requires ongoing access to health services to manage this complex disease process. Adverse events associated with treatment for heart disease have significant immediate and long term effects on patients, caregivers, service providers, and result in increased burden on the health system. Aim: This thesis aimed to investigate adverse events during hospitalisation for heart disease in a large, diverse, regional health district, in particular in the major tertiary referral centre. Methods: This thesis explores the relevance of individual factors, treatment factors, and organisational factors to the occurrence of adverse events in people hospitalised predominantly for acute coronary syndromes. Routine clinical data collection and data linkage systems were developed by the Candidate to facilitate this research. Results: The thesis comprises five individual, interlinking studies: Study 1 “Missed acute myocardial infarction (MAMI) in a rural and regional setting” describes factors associated with missed diagnosis of acute myocardial infarction in a regional setting. Study 2 “Femoral vascular complications following cardiac catheterisation” aimed to determine the predictors of femoral access vascular complications in patients following cardiac catheterisation or percutaneous coronary interventions. Study 3 “A comparison of outcomes during a transition from femoral to radial access in patients presenting with ST segment elevation myocardial infarction” describes the change in practice from femoral artery access to trans-radial artery access in primary percutaneous coronary intervention. Study 4 “Nursing led ultrasound to aid in transradial access in cardiac catheterisation” examined the feasibility of setting up a nurse led approach to identify radial artery complications. Study 5 “Contemporary trends in stroke complicating cardiac catheterisation” determines the causes and outcomes of a post cardiac procedural stroke. Conclusion: This program of research emphasises the role specialised nurses have in monitoring adverse events, improving care and promoting patient safety. This research provides valuable information to inform clinicians for translation to other hospital systems to improve health outcomes for people hospitalised with heart disease.