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Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients
INTRODUCTION: The American Heart Association/American College of Cardiology guidelines recommend rapid door-to-electrocardiography (ECG) times for patients with ST-segment elevation myocardial infarction (STEMI). Previous quality improvement research at our institution revealed that we were not meet...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Department of Emergency Medicine, University of California, Irvine School of Medicine
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307715/ https://www.ncbi.nlm.nih.gov/pubmed/25671039 http://dx.doi.org/10.5811/westjem.2014.10.23277 |
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author | Coyne, Christopher J. Testa, Nicholas Desai, Shoma Lagrone, Joy Chang, Roger Zheng, Ling Kim, Hyung |
author_facet | Coyne, Christopher J. Testa, Nicholas Desai, Shoma Lagrone, Joy Chang, Roger Zheng, Ling Kim, Hyung |
author_sort | Coyne, Christopher J. |
collection | PubMed |
description | INTRODUCTION: The American Heart Association/American College of Cardiology guidelines recommend rapid door-to-electrocardiography (ECG) times for patients with ST-segment elevation myocardial infarction (STEMI). Previous quality improvement research at our institution revealed that we were not meeting this benchmark for walk-in STEMI patients. The objective is to investigate whether simple, directed changes in the emergency department (ED) triage process for potential cardiac patients could decrease door-to-ECG times and secondarily door-to-balloon times. METHODS: We conducted an interventional study at a large, urban, public teaching hospital from April 2010 to June 2012. All patients who walked into the ED with a confirmed STEMI were enrolled in the study. The primary intervention involved creating a chief complaint-based “cardiac triage” designation that streamlined the evaluation of potential cardiac patients. A secondary intervention involved moving our ECG technician and ECG station to our initial triage area. The primary outcome measure was door-to-ECG time and the secondary outcome measure was door-to-balloon time. RESULTS: We enrolled 91 walk-in STEMI patients prior to the intervention period and 141 patients after the invention. We observed statistically significant reductions in door-to-ECG time (43±93 to 30±72 minutes, median 23 to 14 minutes p<0.01), ECG-to-activation time (87±134 to 52±82 minutes, median 43 to 31 minutes p<0.01), and door-to-balloon time (134±146 to 84±40 minutes, median 85 -75 minutes p=0.03). CONCLUSION: By creating a chief complaint-based cardiac triage protocol and by streamlining ECG completion, walk-in STEMI patients are systematically processed through the ED. This is not only associated with a decrease in door-to-balloon time, but also a decrease in the variability of the time sensitive intervals of door-to-ECG and ECG-to-balloon time. |
format | Online Article Text |
id | pubmed-4307715 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Department of Emergency Medicine, University of California, Irvine School of Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-43077152015-02-10 Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients Coyne, Christopher J. Testa, Nicholas Desai, Shoma Lagrone, Joy Chang, Roger Zheng, Ling Kim, Hyung West J Emerg Med Technology in Emergency Medicine INTRODUCTION: The American Heart Association/American College of Cardiology guidelines recommend rapid door-to-electrocardiography (ECG) times for patients with ST-segment elevation myocardial infarction (STEMI). Previous quality improvement research at our institution revealed that we were not meeting this benchmark for walk-in STEMI patients. The objective is to investigate whether simple, directed changes in the emergency department (ED) triage process for potential cardiac patients could decrease door-to-ECG times and secondarily door-to-balloon times. METHODS: We conducted an interventional study at a large, urban, public teaching hospital from April 2010 to June 2012. All patients who walked into the ED with a confirmed STEMI were enrolled in the study. The primary intervention involved creating a chief complaint-based “cardiac triage” designation that streamlined the evaluation of potential cardiac patients. A secondary intervention involved moving our ECG technician and ECG station to our initial triage area. The primary outcome measure was door-to-ECG time and the secondary outcome measure was door-to-balloon time. RESULTS: We enrolled 91 walk-in STEMI patients prior to the intervention period and 141 patients after the invention. We observed statistically significant reductions in door-to-ECG time (43±93 to 30±72 minutes, median 23 to 14 minutes p<0.01), ECG-to-activation time (87±134 to 52±82 minutes, median 43 to 31 minutes p<0.01), and door-to-balloon time (134±146 to 84±40 minutes, median 85 -75 minutes p=0.03). CONCLUSION: By creating a chief complaint-based cardiac triage protocol and by streamlining ECG completion, walk-in STEMI patients are systematically processed through the ED. This is not only associated with a decrease in door-to-balloon time, but also a decrease in the variability of the time sensitive intervals of door-to-ECG and ECG-to-balloon time. Department of Emergency Medicine, University of California, Irvine School of Medicine 2015-01 2014-12-09 /pmc/articles/PMC4307715/ /pubmed/25671039 http://dx.doi.org/10.5811/westjem.2014.10.23277 Text en Copyright © 2015 the authors. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Technology in Emergency Medicine Coyne, Christopher J. Testa, Nicholas Desai, Shoma Lagrone, Joy Chang, Roger Zheng, Ling Kim, Hyung Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients |
title | Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients |
title_full | Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients |
title_fullStr | Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients |
title_full_unstemmed | Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients |
title_short | Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients |
title_sort | improving door-to-balloon time by decreasing door-to-ecg time for walk-in stemi patients |
topic | Technology in Emergency Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307715/ https://www.ncbi.nlm.nih.gov/pubmed/25671039 http://dx.doi.org/10.5811/westjem.2014.10.23277 |
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