Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical center.

Autor: Kohan, Luke C., Nagarajan, Vijaiganesh, Millard, Michael A., Loguidice, Michael J., Fauber, Nancy M., Keeley, Ellen C.
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Zdroj: Vascular Health & Risk Management; Apr2017, Vol. 13, p139-142, 4p
Abstrakt: Objectives: To assess if a change in our cardiology fellowship program impacted our ST elevation myocardial infarction (STEMI) program.Background: Fellows covering the cardiac care unit were spending excessive hours in the hospital while on call, resulting in increased duty hours violations. A night float fellow system was started on July 1, 2012, allowing the cardiac care unit fellow to sign out to a night float fellow at 5:30 pm. The night float fellow remained in-house until the morning.Methods: We performed a retrospective study assessing symptom onset to arrival, arterial access to first device, and door-to-balloon (D2B) times, in consecutive STEMI patients presenting to our emergency department before and after initiation of the night float fellow system.Results: From 2009 to 2013, 208 STEMI patients presented to our emergency department and underwent primary percutaneous coronary intervention. There was no difference in symptom onset to arrival (150±102 minutes vs 154±122 minutes, p=0.758), arterial access to first device (12±8 minutes vs 11±7 minutes, p=0.230), or D2B times (50±32 minutes vs 52±34 minutes, p=0.681) during regular working hours. However, there was a significant decrease in D2B times seen during off-hours (72±33 minutes vs 49±15 minutes, p=0.007). There was no difference in in-hospital mortality (11% vs 8%, p=0.484) or need for intra-aortic balloon pump placement (7% vs 8%, p=0.793).Conclusion: In academic medical centers, in-house cardiology fellow coverage during off-hours may expedite care of STEMI patients. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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