We observed that the length of stay in the ED needs to be stratified by case mix and the total number of visits of the ED.
A number of factors can be used to identify STEMI patients who are less likely to be managed according to guidelines. Training focused on these factors should improve management and clinical outcomes of STEMI.
Objectives and BackgroundThe objective was to evaluate the emergency care of patients presenting with ST+ACS in the context of the recommendations of the French Societies of Emergency Medicine and Cardiology with a view to reducing ACS morbi-mortality: the use of the SAMU call center; antiplatelet treatment; admission in cardiology intensive care unit (CICU), reperfusion therapy rate>75%; delay from first medical contact to electrocardiogram (ECG) interpretation <10 min; to angioplasty (door to balloon) <90 min; to thrombolysis (door to needle) <30 min.ProgramA multicentre, longitudinal, multidisciplinary register covering the Department. Every patient seen by an emergency physician for an ST+ACS within 12 h either by prehospital, by a mobile intensive care unit (MICU) or presenting themselves at the public and private emergency rooms (ER) was included and followed for one month. The data regarding treatments and delays and in hospital mortality were recorded in prehospital, in ER or after transfer to CICU. The Haute Autorité de Santé clinical practice indicators were used and descriptive statistical analyses carried out with the delays expressed as medians (interquartile). The main measures were compared between the patients arriving via the MICU and those presenting ER, using the chi-square (qualitative variables) and the Mann–Whitney test (quantitative variables).ResultsBetween January 2007 and June 2008, 417 patients were included (mean age 62; sex ratio 3.1), with 80% by the MICU after calling the SAMU. The completion rate was 96%. The time between the onset of pain and first medical contact was 97 min (54–180), that is, <3 h for 75% of the patients. An ECG was done in 7 min (5–13). The rate of admission to the CICU was 98% with a delay of 89 min (60–136), with 9% being under 45 min. The antiplatelet therapy (aspirin and clopidogrel) rate was 85%. The rate of reperfusion was 96%, of which 65% by primary angioplasty and 32% by thrombolytic therapy. The median door to balloon delay was 136 min (97–208) and door to needle delay 20 min (10–24). The in-hospital mortality rate was 4.3%.MICU and ER comparison: reperfusion rate was ≥95%, with no significant difference reported (respectively, 95.5% vs 97.5%, p=0.39). MICU patients had significantly shorter treatment delays: door to balloon (122 min vs 196, p=0.0001), door to needle (20 min vs 28, p=0.001), door to ECG (6 min vs 11, p=0.001). Antiplatelet agents prescription was high, with no reported significant difference (85% vs 86%, p=0.94).DiscussionThe register enables to objectively compare the emergency systems using the relevant medical indicators. The results are in agreement with the standard recommendations, with the exception of the time of door to balloon, which should be improved. The longer waiting times seen for the independent arrivals in Emergency confirms, in the case of chest pain, the necessity of a recourse to the SAMU call centre number 15 in the first instance.ConclusionThe register enables the emergency care routes to be evaluated and confirms...
ObjectivesA stroke is an emergency that must be investigated early and rapidly to find the cause and give appropriate treatment. When a stroke is suspected it is recommended in the first instance to call the medical emergency telephone centre (Centre 15). The aim of this registry was to study the emergency care managment followed for suspected stroke patients and to evaluate the impact of the recourse to the Centre 15ProgramIn April 2008 a registry of current practice was established by the Observatoire Régional des Urgences de Midi-Pyrénees within all the public emergency services of the Haute Garonne. All patients over the age of 18 suspected or having an acute stroke were included by the call-centre of the prehospital (SAMU31, SMUR) or the emergency services.The current evaluation concerns the patients taken care of by the St Gaudens Hospital Centre (SMUR and emergency department) over a period of 15 months. This establishment covers a population catchment's of 75 000 inhabitants and is situated in the south of the Department, one hour from the Toulouse University Hospital which houses the neurovascular unit and the SAMU. The St Gaudens Hospital Centre has a CT scan but no neurological specialist.ResultsTwo hundred twenty six patients were included in the study between the 1st of April 2008 and the 30th of June 2009. They had a mean age of 79 (range 32-97) and a sex ratio of 0.45. The completion rate was 100%.Fifty eight per cent of the patients were stabilised by the SAMU31, either as a result of a direct call to the centre 15 or after contact made by an independent doctor, and of these patients 9.3 % were taken by the SMUR in St Gaudens. Among the patients arriving directly at the emergency department (ED) without prior stabilisation (42 %), 56 % had contacted an independent doctor in the first instance.The median delay ‘onset of symptoms—arrival at the ED’ for all patients was 151 min (range 86–352). It was shorter (146 vs 155 min; p=0.67) for stabilised patients. The median length of time in the ED was 210 min overall and was shorter for the stabilised patients (190 vs 239 min; p=0.06). The delay between arriving in ED and clinical examination was significantly shorter for stabilised patients (11 vs 26 min; p<0.0001). A neurologist at the University Hospital was contacted by the emergency physician for 29 % of all patients; 25 % of the stabilised patients and 34 % of the non-stabilised (p=0.13). The results of thrombolysis are currently being consolidated and will be available for the symposium.DiscussionThe registry enables the care systems to be objectively compared and our results confirm the positive clinical impact of an intervention following a call to the centre 15: a shorter time in emergency and earlier treatment. The gain in time is estimated to be 15 min, which enables the rate of patients eligible for thrombolysis to be increased. However, only 58% of patients follow this route.This record will enable us to evaluate the impact of (1) setting up information campaigns on the rate of initial calls ...
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