Sharing and Teaching Electrocardiograms to Minimize Infarction (STEMI): reducing diagnostic time for acute coronary occlusion in the emergency department
| Autor: | Soojin L. Yi, Lucas B. Chartier, Ahmed Taher, Jesse T.T. McLaren, Monika Kapoor |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Delayed Diagnosis Time Factors Formative Feedback Infarction Culprit Time-to-Treatment Electrocardiography 03 medical and health sciences 0302 clinical medicine medicine Humans cardiovascular diseases Myocardial infarction Aged Internet Clinical Audit medicine.diagnostic_test business.industry Outcome measures 030208 emergency & critical care medicine General Medicine Emergency department Middle Aged medicine.disease Quality Improvement Confidence interval Coronary Occlusion Coronary occlusion Acute Disease Emergency medicine Emergency Medicine ST Elevation Myocardial Infarction Education Medical Continuing Female Emergency Service Hospital business |
| Zdroj: | The American Journal of Emergency Medicine. 48:18-32 |
| ISSN: | 0735-6757 |
| Popis: | Background Limits to ST-Elevation Myocardial Infarction (STEMI) criteria may lead to prolonged diagnostic time for acute coronary occlusion. We aimed to reduce ECG-to-Activation (ETA) time through audit and feedback on STEMI-equivalents and subtle occlusions, without increasing Code STEMIs without culprit lesions. Methods This multi-centre, quality improvement initiative reviewed all Code STEMI patients from the emergency department (ED) over a one-year baseline and one-year intervention period. We measured ETA time, from the first ED ECG to the time a Code STEMI was activated. Our intervention strategy involved a grand rounds presentation and an internal website presenting weekly local challenging cases, along with literature on STEMI-equivalents and subtle occlusions. Our outcome measure was ETA time for culprit lesions, our process measure was website views/visits, and our balancing measure was the percentage of Code STEMIs without culprit lesions. Results There were 51 culprit lesions in the baseline period, and 64 in the intervention period. Median ETA declined from 28.0 min (95% confidence interval [CI] 15.0–45.0) to 8.0 min (95%CI 6.0–15.0). The website garnered 70.4 views/week and 27.7 visitors/week in a group of 80 physicians. There was no change in percentage of Code STEMIs without culprit lesions: 28.2% (95%CI 17.8–38.6) to 20.0% (95%CI 11.2–28.8%). Conclusions Our novel weekly web-based feedback to all emergency physicians was associated with a reduction in ETA time by 20 min, without increasing Code STEMIs without culprit lesions. Local ECG audit and feedback, guided by ETA as a quality metric for acute coronary occlusion, could be replicated in other settings to improve care. |
| Databáze: | OpenAIRE |
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