Primary percutaneous coronary intervention (PPCI) is the preferred method of reperfusion for ST-segment elevation myocardial infarction (STEMI), if it can be performed in a timely manner by an experienced interventional cardiologist at a high volume STEMI Receiving Center. However, an estimated 50% of STEMI patients present to STEMI Referral Centers without PPCI capability. Transfer of STEMI patients for PPCI has been shown to improve outcomes as compared with fibrinolysis given at the presenting hospital. Nonetheless, transfer of STEMI patients for PPCI has not been used extensively in the United States and is associated with markedly prolonged transfer times. This study demonstrates that rapid transfer of STEMI patients from community hospitals without PPCI capability to a STEMI Receiving Center is both safe and feasible using a standardized protocol with an integrated transfer system.
BackgroundWe evaluated the first‐medical‐contact‐to‐balloon (FMC2B) time after implementation of a “Call 911” protocol for ST‐segment–elevation myocardial infarction (STEMI) interfacility transfers in a regional system.Methods and ResultsThis is a retrospective cohort study of consecutive patients with STEMI requiring interfacility transfer from a STEMI referring hospital, to one of 35 percutaneous coronary intervention‐capable STEMI receiving centers (SRCs). The Call 911 protocol allows the referring physician to activate 911 to transport a patient with STEMI to the nearest SRC for primary percutaneous coronary intervention. Patients with interfacility transfers were identified over a 4‐year period (2011–2014) from a registry to which SRCs report treatment and outcomes for all patients with STEMI transported via 911. The primary outcomes were median FMC2B time and the proportion of patients achieving the 120‐minute goal. FMC2B for primary 911 transports were calculated to serve as a system reference. There were 2471 patients with STEMI transferred to SRCs by 911 transport during the study period, of whom 1942 (79%) had emergent coronary angiography and 1410 (73%) received percutaneous coronary intervention. The median age was 61 years (interquartile range [IQR] 52–71) and 73% were men. The median FMC2B time was 111 minutes (IQR 88–153) with 56% of patients meeting the 120‐minute goal. The median STEMI referring hospital door‐in‐door‐out time was 53 minutes (IQR 37–89), emergency medical services transport time was 9 minutes (IQR 7–12), and SRC door‐to‐balloon time was 44 minutes (IQR 32–60). For primary 911 patients (N=4827), the median FMC2B time was 81 minutes (IQR 67–97).ConclusionsUsing a Call 911 protocol in this regional cardiac care system, patients with STEMI requiring interfacility transfers had a median FMC2B time of 111 minutes, with 56% meeting the 120‐minute goal.
Introduction: The patient experience for a newly diagnosed stroke patient can be psychologically devastating. Limited research exists on stroke patients with pre-existing psychiatric conditions, including implications on quality of life, outcomes, readmissions, compliance and utilization of resources. The majority of the research focuses on depression post stroke diagnosis or discharge. Stroke patients are known to be vulnerable to psychological issues after a stroke diagnosis. However, we are limited in understanding how the hospital experience is for new stroke patients with preexisting psychiatric illness including: whether or not sufficient support is being provided during their hospital admission; is the underlying psychiatric illness preventing them from meeting functional milestones; and are they prepared for discharge? Methods: The study design is a retrospective chart review of newly diagnosed stroke patients with a previous psychiatric diagnosis admitted between January to June 2018. Data on sociodemographic, disease, treatment, assessment and utilization of resources were collected in a retrospective chart tool. Psychiatric variables were collected from consultation and progress notes dictated by psychiatry, social work, care coordination and other care providers. Results: We reviewed forty-six charts that met the eligibility criteria. Gender was 56.5% female/43.5% male; average age 72 (age range 41-100) and average length of stay 9 days. Of these patients 39.1% had two or more psychiatric diagnoses. Common psychiatric diagnoses were anxiety (50%), depression (39.1%), “Other” was schizophrenia, bipolar disorder and delirium. Higher rates of substance use, distress, current family conflict and no social support or caregiver concerns were found in this subset of stroke patients. Conclusion: Data from this study provides a glance at the psychosocial issues new stroke patients with previous psychiatric history experience. Areas for further research in the realm of education, psychosocial support and distress screening are needed. Results can be used as a foundation for developing and/or refining hospital assessments and may assist those in planning services and resources needed for stroke survivors.
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