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Abstract
Background Chest pain attendances at the emergency department (ED) in the UK are continuing to rise. Chest pain units (CPU) provide nurse-led, protocol-driven care for patients attending the ED with acute chest pain. The ESCAPE trial evaluated the effectiveness, cost-effectiveness and acceptability of CPU care in the NHS. This paper reports the quantitative evaluation of acceptability: patient satisfaction with CPU and routine care.
Methods The ESCAPE study was a cluster-randomised controlled trial of 14 hospitals in which seven hospitals were allocated to establish CPU care and seven to continue providing routine care. As part of the study, postal questionnaires were sent to a subgroup of patients attending the ED with chest pain before and after intervention at all 14 hospitals.
Results There was a 42.8% response rate (2389/5584) for unsolicited self-administered questionnaires. There was no significant change in any dimension of patient satisfaction, although there was some weak evidence that the introduction of CPU care was associated with reduced satisfaction with explanations about medical procedures and treatments (effect of CPU −0.16 points on a 5-point Likert scale, 95% CI −0.35 to 0.02; p=0.089) and attention given to what the patient had to say (−0.17 points, 95% CI −0.35 to 0.02; p=0.077). CPU care had no effect on overall satisfaction with care (−0.08 points, 95% CI −0.26 to 0.10; p=0.393).
Conclusions No evidence was found that improvements in patient satisfaction associated with CPU care in previous single-centre trials were reproduced in this multicentre study.
Trial registration number ISRCTN55318418 International Standard Randomised Controlled Trial Number Register.
- Acute chest pain
- chest pain units
- emergency care systems
- emergency department
- patient satisfaction
- randomised controlled trial
- research
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Footnotes
For members of the ESCAPE Research Team see the end of the article.
Project management group: Jane Arnold, research fellow, University of Sheffield (clinical manager); Simon Capewell, professor of clinical epidemiology, University of Liverpool (northwest lead); Liz Cross, research associate, University of Sheffield (research manager); Steve Goodacre, professor of emergency medicine, University of Sheffield (principal investigator); Maxine Johnson, research associate, University of Sheffield (qualitative researcher); Cath Lewis, research associate, University of Liverpool (northwest coordinator); Francis Morris, consultant in emergency medicine, Northern General Hospital, Sheffield (chest pain unit adviser); Jon Nicholl, director MCRU policy research programme, University of Sheffield (statistician); Yemi Oluboyede, research associate, University of Sheffield (health economist); Susan Read, honorary research fellow, University of Sheffield (nursing adviser); Angela Tod, principal research fellow, Centre for Health and Social Care Research, Sheffield Hallam University (qualitative adviser).
Trial Steering Committee: Phil Adams, consultant cardiologist, Newcastle upon Tyne NHS Foundation Trust (co-applicant); Tim Coats, professor of emergency medicine, University of Leicester (independent member); Nicky Cullum, professor, Centre for Evidence Based Nursing, University of York (independent chair); Alasdair Gray, consultant in emergency medicine, Edinburgh Royal Infirmary (co-applicant); Enid Hirst (lay member); Jason Kendall, consultant in emergency medicine, Frenchay Hospital, Bristol (independent member); David Newby, professor of cardiology, University of Edinburgh (co-applicant); Simon Dixon, senior lecturer, University of Sheffield (health economist).
Data Monitoring Committee: Jonathan Benger, consultant in emergency medicine, Bristol Royal Infirmary; David Gray, reader in medicine and honorary consultant physician, Epidemiology and Health Services Research Unit, Queen's Medical Centre, Nottingham; Robin Prescott, statistical adviser, Medical Statistics Unit, Public Health Sciences, University of Edinburgh.
Principal trial staff: University Hospital Aintree—John Hollingsworth (ED lead), Erwin Rodrigues (cardiology lead), Paula McCarten (cardiac specialist nurse); Whiston Hospital—David Roe (ED lead), Dave Johns (chest pain nurse); Halton General Hospital—Serge Osula (cardiology lead), Karen Randles (cardiac nurse specialist); Wythenshawe Hospital—Darren Walter (ED lead); Warrington Hospital—Steve Crowder (ED lead), Cindy Lancaster (ED nurse); West Cumberland Hospital—Charles Brett (ED lead), Guy Bickerton (ED lead); Peterborough District Hospital—Rob Russell (ED lead); Dewsbury and District Hospital—Dean Okereke (ED lead); Scunthorpe General Hospital—Ajay Chawla (ED lead), Julia Lindley (administration/systems manager), Julie Housham (chest pain nurse), Sarah McGugan (chest pain nurse); Queen's Medical Centre Nottingham—Frank Coffey (ED lead), Phil Miller (ED research coordinator); Taunton and Somerset Hospital—Cliff Mann (ED lead), Andria Haffenden (chest pain nurse), Bridget Capewell (chest pain nurse); Hairmyres Hospital—John Keaney (ED lead); City Hospital Birmingham—Nigel Langford (MAU lead); Worcestershire Royal Hospital—Rose Johnson (ED lead), David Pitcher (cardiology lead), Sue Amos (chest pain nurse), Sally Baker (chest pain nurse).
Department of Health disclaimer: The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Department of Health.
Under our contract with the Department of Health all publications arising from the research are covered by Crown Copyright.
Funding This study was funded by the NHS Service Delivery and Organisation R&D Programme (now NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC)).
Competing interests None.
Ethical approval This study was conducted with the approval of the Thames Valley Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
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