Timeliness of interfacility transfer for ED patients with ST-elevation myocardial infarction
| Autor: | Daniel Muñoz, Timothy J. Vogus, Sunil Kripalani, Robert S. Dittus, Carol Scott, Eric J. Thomassee, Theodore Speroff, Michael E. Matheny, Michael J. Ward, Dandan Liu, Alan B. Storrow, Joseph L. Fredi |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Male
Patient Transfer medicine.medical_specialty Time Factors Cardiac Care Facilities medicine.medical_treatment Myocardial Infarction Article Time-to-Treatment Electrocardiography Percutaneous Coronary Intervention Interquartile range medicine Humans cardiovascular diseases Myocardial infarction Aged Retrospective Studies medicine.diagnostic_test business.industry ST elevation Percutaneous coronary intervention Retrospective cohort study General Medicine Middle Aged medicine.disease Surgery surgical procedures operative Emergency medicine Conventional PCI Cohort Emergency Medicine Female business Emergency Service Hospital |
| Zdroj: | The American journal of emergency medicine. 33(3) |
| ISSN: | 1532-8171 |
| Popis: | Objectives Most US hospitals lack primary percutaneous coronary intervention (PCI) capabilities to treat patients with ST-elevation myocardial infarction (STEMI) necessitating transfer to PCI-capable centers. Transferred patients rarely meet the 120-minute benchmark for timely reperfusion, and referring emergency departments (EDs) are a major source of preventable delays. We sought to use more granular data at transferring EDs to describe the variability in length of stay at referring EDs. Methods We retrospectively analyzed a secondary data set used for quality improvement for patients with STEMI transferred to a single PCI center between 2008 and 2012. We conducted a descriptive analysis of the total time spent at each referring ED (door-in–door-out [DIDO] interval), periods that comprised DIDO (door to electrocardiogram [EKG], EKG-to-PCI activation, and PCI activation to exit), and the relationship of each period with overall time to reperfusion (medical contact-to-balloon [MCTB] interval). Results We identified 41 EDs that transferred 620 patients between 2008 and 2012. Median MCTB was 135 minutes (interquartile range [IQR] 114,172). Median overall ED DIDO was 74 minutes (IQR 56,103) and was composed of door to EKG, 5 minutes (IQR 2,11); EKG-to-PCI activation, 18 minutes (IQR 7,37); and PCI activation to exit, 44 minutes (IQR 34,56). Door-in door-out accounted for the largest proportion (60%) of overall MCTB and had the largest variability (coefficient of variability, 1.37) of these intervals. Conclusions In this cohort of transferring EDs, we found high variability and substantial delays after EKG performance for patients with STEMI. Factors influencing ED decision making and transportation coordination after PCI activation are a potential target for intervention to improve the timeliness of reperfusion in patients with STEMI. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect