Patient-needs-enhanced emergency nursing assessment framework accelerates time-critical care for non-traumatic chest pain.

Background: Non-traumatic chest pain requires rapid Emergency Department (ED) triage, yet adherence to ECG ≤10 min and early troponin targets is inconsistent, standard nursing frameworks seldom prompt patient-needs that affect timeliness and documentation. The aim of this study is to determine whether implementing a patient-needs-enhanced Emergency Nursing Assessment Framework (ENAF), compared with usual care, increases the proportion of ED patients with non-traumatic chest pain receiving a 12-lead ECG within 10 min. Methods: This prospective single-center quasi-experimental before-after study was conducted in the T Third Affiliated Hospital of Naval Medical University from January 2023 to January 2025 and assigned to a control group and ENAF group. The ENAF group comprised (1) eight hours of nurse training, (2) an ENAF electronic template incorporating mandatory pain, anxiety, information-need and social-support items, and (3) a triage "rapid chest-pain kit". The primary endpoint was completion of a 12-lead ECG within 10 min of triage; secondary endpoints were door-to-troponin time, ≥2-point pain reduction at 30 min, documentation completeness, ED length of stay (LOS) and 30-day major adverse cardiac events (MACE). Multivariable logistic regression adjusted for age, sex, HEART score, arrival mode and peak ED census. Results: Of 372 screened patients, 340 met eligibility and were analyzed (170 control, 170 ENAF). Timely ECG completion increased from 60.0% to 78.2% (adjusted odds ratio 2.31, 95% CI: 1.47-3.63; P < 0.001). Median door-to-troponin time fell from 50 to 39 min (P < 0.001); pain-relief success rose from 45.3% to 61.8% (P = 0.002). Documentation completeness improved by ten percentage points (P < 0.001) and median ED LOS decreased by 0.8 h (P = 0.01). Thirty-day MACE was similar between phases (15.3% vs. 12.9%; P = 0.49), and no serious adverse events were attributed to the protocol. Conclusions: Augmenting ENAF with a structured clinical-needs module significantly accelerates ECG acquisition, improves other process metrics and enhances nursing documentation while maintaining patient safety. Adoption of this nurse-led approach could strengthen ED chest-pain pathways in comparable resource-constrained settings, and multicenter validation are warranted to establish generalizability.