scholarly journals A modified chief complaint-based cardiac triage strategy for reducing delays in the management of patients with ST-elevation myocardial infarction

2021 ◽  
Author(s):  
Hung-Yuan Su ◽  
Jen-Long Tsai ◽  
Yin-Chou Hsu ◽  
Kuo-Hsin Lee ◽  
Chao-Sheng Chang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intervention Group ◽  
Chief Complaint ◽  
St Elevation Myocardial Infarction ◽  
Post Intervention ◽  
Tertiary Referral Center ◽  
Before And After ◽  
St Elevation ◽  
Delays In Diagnosis ◽  
Door To Balloon

Abstract Timely performing electrocardiography (ECG) is crucial for early detection of ST-elevation myocardial infarction (STEMI). For shortening door-to-ECG time, a chief complaint-based “cardiac triage” protocol comprising (1) raising alert among medical staff with bedside triage tags, and (2) immediate bedside ECG after focused history-taking was implemented at the emergency department (ED) in a single tertiary referral center. All patients diagnosed with STEMI visiting the ED between November 2017 and January 2020 were retrospectively reviewed to investigate the effectiveness of strategy before and after implantation. Analysis of a total of 117 ED patients with STEMI (pre-intervention group, n = 57; post-intervention group, n = 60) showed significant overall improvements in median door-to-ECG time from 5 to 4 minutes (p = 0.02), achievement rate of door-to-ECG time < 10 minutes from 45–57% (p = 0.01), median door-to-balloon time from 81 to 70 minutes (p < 0.01). Significant trends of increase in achievement rates for door-to-ECG and door-to-balloon times (p = 0.01 and p = 0.006, respectively) was noticed after strategy implementation. The incidence of door-to-ECG time > 10 minutes for those with initially underestimated disease severity was also reduced from 90–10% (p < 0.01). In conclusion, a chief complaint-based “cardiac triage” strategy successfully improved the quality of emergency care for STEMI patients through reducing delays in diagnosis and treatment.

scholarly journals A modified cardiac triage strategy reduces door to ECG time in patients with ST elevation myocardial infarction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hung-Yuan Su ◽  
Jen-Long Tsai ◽  
Yin-Chou Hsu ◽  
Kuo-Hsin Lee ◽  
Chao-Sheng Chang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intervention Group ◽  
Chief Complaint ◽  
St Elevation Myocardial Infarction ◽  
Post Intervention ◽  
Tertiary Referral Center ◽  
Before And After ◽  
St Elevation ◽  
Delays In Diagnosis ◽  
Door To Balloon

AbstractTimely performing electrocardiography (ECG) is crucial for early detection of ST-elevation myocardial infarction (STEMI). For shortening door-to-ECG time, a chief complaint-based “cardiac triage” protocol comprising (1) raising alert among medical staff with bedside triage tags, and (2) immediate bedside ECG after focused history-taking was implemented at the emergency department (ED) in a single tertiary referral center. All patients diagnosed with STEMI visiting the ED between November 2017 and January 2020 were retrospectively reviewed to investigate the effectiveness of strategy before and after implantation. Analysis of a total of 117 ED patients with STEMI (pre-intervention group, n = 57; post-intervention group, n = 60) showed significant overall improvements in median door-to-ECG time from 5 to 4 min (p = 0.02), achievement rate of door-to-ECG time < 10 min from 45 to 57% (p = 0.01), median door-to-balloon time from 81 to 70 min (p < 0.01). Significant trends of increase in achievement rates for door-to-ECG and door-to-balloon times (p = 0.032 and p = 0.002, respectively) was noted after strategy implementation. The incidences of door-to-ECG time > 10 min for those with initially underestimated disease severity (from 90 to 10%, p < 0.01) and walk-in (from 29.2 to 8.8%, p = 0.04) were both reduced. In conclusion, a chief complaint-based “cardiac triage” strategy successfully improved the quality of emergency care for STEMI patients through reducing delays in diagnosis and treatment.

scholarly journals A Modified Chief Complaint-Based Cardiac Triage Strategy for Reducing Delays in the Management of Patients With ST-Elevation Myocardial Infarction

2020 ◽  
Author(s):  
Hung-Yuan Su ◽  
Jen-Long Tsai ◽  
Yin-Chou Hsu ◽  
Kuo-Hsin Lee ◽  
Chao-Sheng Chang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Intervention Strategy ◽  
Intervention Group ◽  
Strategy Implementation ◽  
Chief Complaint ◽  
St Elevation Myocardial Infarction ◽  
Post Intervention ◽  
Achievement Rate ◽  
St Elevation

Abstract Background: This study aimed at investigating the efficacy of utilizing a modified cardiac triage strategy at the emergency department for timely detection of ST-elevation myocardial infarction (STEMI).Methods: A chief complaint-based “cardiac triage” protocol comprising (1) raising alert among medical staff with bedside triage tags, and (2) immediate bedside electrocardiography (ECG) after focused history-taking was implemented at the emergency department of a single tertiary referral center since December 2018. All patients diagnosed with STEMI visiting the emergency department (ED) between November 2017 and January 2020 were retrospectively reviewed to investigate the effectiveness of the strategy by comparing the primary [i.e., door-to-ECG (DTE) time and achievement rate of DTE time<10 minutes] and secondary [i.e., door-to-balloon (DTB) time and achievement rate of DTB time<90 minutes] outcomes among STEMI patients before (pre-intervention) and after (post-intervention) strategy implementation.Results: Analysis of a total of 117 ED patients with STEMI (pre-intervention group, n=57; post-intervention group, n=60) showed significant overall improvements in median DTE time from 5 to 4 minutes (p=0.02), achievement rate of DTE time<10 minutes from 45% to 57% (p=0.01), median DTB time from 81 to 70 minutes (p<0.01). Significant trends were also noted in achievement rates for DTE and DTB times (p=0.01 and p=0.006, respectively) after strategy implementation. The incidence of DTE time>10 minutes for those with initially underestimated disease severity was also reduced from 90% to 10% (p<0.01).Conclusions: A chief complaint-based “cardiac triage” strategy successfully improved the quality of emergency care for STEMI patients through reducing delays in diagnosis and treatment.

Door-to-balloon time and mortality in patients with ST-elevation myocardial infarction undergoing primary angioplasty

2020 ◽  
Author(s):  
Basheer Karkabi ◽  
Gal Meir ◽  
Barak Zafrir ◽  
Ronen Jaffe ◽  
Salim Adawi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Quality Improvement ◽  
St Elevation Myocardial Infarction ◽  
Quality Improvement Intervention ◽  
Entire Cohort ◽  
Number Of Patients ◽  
Before And After ◽  
St Elevation ◽  
Door To Balloon ◽  
Improvement Intervention

Abstract Aims The evidence are not conclusive that a small incremental increase in door-to-balloon (D2B) time leads to a significant increase in death of ST-elevation myocardial infarction (STEMI) patients. In a previous study, we described a quality improvement intervention that reduced D2B time in 333 patients with STEMI. The aim of the current study was to compare mortality rates of the patients, before and after the intervention. Methods and results We examined the survival of 133 consecutive patients with STEMI treated prior to an intervention to decrease D2B time and 200 treated after the intervention. The mortality rate was the same before and after the quality intervention. The median D2B time for the entire cohort was 55 min. The number of patients with D2B time &gt;55 min prior to the intervention was 82/133 (61%) and after the intervention 74/200 (37%) P &lt; 0.00001. Thirty-day mortality among the patients with D2B time ≤55 min was 5/178 (2.8%) and among those with D2B time &gt;55 min was 15/155 (9.7%), P &lt; 0.008. The hazard ratio for 30-day mortality when the D2B time was &gt;55 min was 3.7 (1.3–10.4). Conclusion Mortality and non-fatal complications did not differ significantly between STEMI patients before and after a quality improvement intervention. However, the number of patients treated within 55 min from arrival was significantly higher after the intervention; and coronary intervention within this time was associated with a lower death rate.

scholarly journals (A80) Nationwide Study to Improve Door-to-Balloon Times in Patients with Acute St Elevation Myocardial Infarction Requiring Primary Percutaneous Coronary Intervention Using Prehospital ECG Transmission

2011 ◽  
Vol 26 (S1) ◽  
pp. s22-s22
Author(s):  
M.E. Ong ◽  
A.S. Wong ◽  
S.G. Teo ◽  
C.M. Seet ◽  
B.L. Lim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Ambulance Service ◽  
St Elevation Myocardial Infarction ◽  
Percutaneous Coronary ◽  
Before And After ◽  
St Elevation ◽  
Door To Balloon

ObjectiveTo reduce nationwide door-to-balloon times (DTB) in patients presenting with acute ST-elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI), by adoption of pre-hospital wireless 12-lead electrocardiogram (ECG) transmission by Singapore's national ambulance service.MethodsA phased, prospective, before-after, interventional study of all patients who presented to the national ambulance service with the diagnosis of STEMI. In the ‘Before’ phase, chest pain patients only received 12-lead ECGs on arrival at the Emergency Departments (ED), where diagnosis of STEMI could be made. In the ‘After’ phase, 12-lead ECGs were performed in the field by ambulance crews and transmitted while en-route to the hospitals. Diagnoses of STEMI was made by on-duty emergency physicians (EP) prior to patients' arrival and PCI activated. Data was collected from ambulance run sheets, ECG transmission logs, EDs and cardiology units.Results451 eligible patients from “Before” and 214 patients from “After” phase were included in the analysis. Median DTB time was 88 minutes in the “Before” and 52 minutes in the “After” phase (p = 0.0001). During office hours, median DTB times for ‘Before’ and ‘After’ phases were 84 minutes and 47 minutes, respectively (p = 0.0001). After office hours, median DTB times for ‘Before’ and ‘After’ phases were 95 minutes and 54 minutes, respectively (p = 0.0001). There were 11 false positive activations in “Before” phase and one in the “After” phase.ConclusionPre-hospital ECG transmission resulted in significant reduction of DTB time; this effect occurred regardless of whether patients presented to the ED before or after office hours. No increase in false activations was found in the “After” phase. Pre-hospital ECG transmission should be adopted as “standard of care” for all STEMI cases meeting the criteria for PCI.

Direct cost of treatment in patients with acute ST-elevation myocardial infarction in Vietnam

MedPharmRes ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. 7-11
Author(s):  
Sy Van Hoang ◽  
Tuan Thanh Tran ◽  
Kha Minh Nguyen
Keyword(s):  
Myocardial Infarction ◽  
Direct Cost ◽  
Treatment Cost ◽  
Financial Burden ◽  
Intervention Group ◽  
St Elevation Myocardial Infarction ◽  
Related Factors ◽  
Female Ratio ◽  
Conservative Group ◽  
St Elevation

Background: Acute myocardial infarction has become a serious financial burden for patients, healthcare system, and society. It is therefore necessary to assess treatment cost of myocardial infarction that had been conducted in many countries in the world and still not fully analysed in Vietnam. Thus, we sought to describe acute ST-elevation myocardial infarction treatment cost and analyse related factors to acute ST-elevation myocardial infarction treatment cost. Methods and Materials: A retrospective cross-sectional study. Patients who was diagnosed by ST-elevation myocardial infarction at Cho Ray Hospital from June 2018 to February 2019, satisfied inclusion and exclusion criteria. Results: We collected 130 patients with acute ST-elevation myocardial infarction with male: female ratio of 3:1, at average age of mean ± Standard deviation (SD) = 62.9 ± 12.6. The length of stay in hospital was mean ± SD = 7.1 ± 3.3 days and the median direct cost of MI was 68,902,500 VND (interquartile range (IQR): 5,737,200 – 104,266,000 VND). The average total cost of acute ST-elevation myocardial infarction in the percutaneous coronary intervention group was more than 16 times as the conservative group. The treatment strategies and hospital complications were major factors that affected treatment cost. Conclusion: The median direct cost of acute ST-elevation myocardial infarction was accounted for 68,902,500 VND. Complications directly affected costs.

scholarly journals Evaluation of a regional ST-elevation myocardial infarction primary percutaneous coronary intervention program at the Rouge Valley Health System

2021 ◽  
Author(s):  
Pria MD Nippak ◽  
Jodie Pritchard ◽  
Robin Horodyski ◽  
Candace J Ikeda-Douglas ◽  
Winston W Isaac
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Primary Pci ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Door To Balloon

Background ST-elevation myocardial infarction (STEMI) remains the second leading cause of death in Canada. Primary percutaneous coronary intervention (PCI) has been recognized as an effective method for treating STEMI. Improved access to primary PCI can be achieved through the implementation of regional PCI centres, which was the impetus for implementing the PCI program in an east Toronto hospital in 2009. As such, the purpose of this study was to measure the efficacy of this program regional expansion. Methods A retrospective review of 101 patients diagnosed with STEMI from May to Sept 2010 was conducted. The average door-to-balloon time for these STEMI patients was calculated and the door-to-balloon times using different methods of arrival were analyzed. Method of arrival was by one of three ways: paramedic initiated referral; patient walk-ins to PCI centre emergency department; or transfer after walk-in to community hospital emergency department. Results The study found that mean door-to balloon time for PCI was 112.5 minutes. When the door-to-balloon times were compared across the three arrival methods, patients who presented by paramedic-initiated referral had significantly shorter door-to-balloon times, (89.5 minutes) relative to those transferred (120.9 minutes) and those who walked into a PCI centre (126.7 minutes) (p = 0.047). Conclusions The findings suggest that the partnership between the hospital and its EMS partners should be continued, and paramedic initiated referral should be expanded across Canada and EMS systems where feasible, as this level of coverage does not currently exist nationwide. Investments in regional centres of excellence and the creation of EMS partnerships are needed to enhance access to primary PCI.

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