ObjectivesTo assess if a change in our cardiology fellowship program impacted our ST elevation myocardial infarction (STEMI) program.BackgroundFellows covering the cardiac care unit were spending excessive hours in the hospital while on call, resulting in increased duty hours violations. A night float fellow system was started on July 1, 2012, allowing the cardiac care unit fellow to sign out to a night float fellow at 5:30 pm. The night float fellow remained in-house until the morning.MethodsWe performed a retrospective study assessing symptom onset to arrival, arterial access to first device, and door-to-balloon (D2B) times, in consecutive STEMI patients presenting to our emergency department before and after initiation of the night float fellow system.ResultsFrom 2009 to 2013, 208 STEMI patients presented to our emergency department and underwent primary percutaneous coronary intervention. There was no difference in symptom onset to arrival (150±102 minutes vs 154±122 minutes, p=0.758), arterial access to first device (12±8 minutes vs 11±7 minutes, p=0.230), or D2B times (50±32 minutes vs 52±34 minutes, p=0.681) during regular working hours. However, there was a significant decrease in D2B times seen during off-hours (72±33 minutes vs 49±15 minutes, p=0.007). There was no difference in in-hospital mortality (11% vs 8%, p=0.484) or need for intra-aortic balloon pump placement (7% vs 8%, p=0.793).ConclusionIn academic medical centers, in-house cardiology fellow coverage during off-hours may expedite care of STEMI patients.
Background: For patients presenting with ST segment elevation myocardial infarction (STEMI), door-to-balloon (or first device) time (D2B) is effected by multiple patient and system-based factors. We hypothesized that fellow and/or catheterization (cath) team in-hospital call would result in decreased D2B time. Methods: We collected data from our hospital's STEMI database and the electronic medical record. Patients were divided into two groups based on whether the fellow was taking home or in-hospital call. A subgroup analysis included whether the cath lab team was in-hospital or at home. The mean difference in D2B between the groups was calculated using independent T test and one-way ANOVA test. Results: From a total of 313 patients presented with STEMI and underwent emergency coronary angiography: 186 presented when the fellow was taking home call, and 127 presented while the fellow was taking inhospital call. Mean D2B was significantly lower (44 min vs. 56 min, p< 0.01) when the fellow was taking in-hospital call (Figure 1). In a subgroup analysis, D2B times were highest when the fellow and cath team were home, and lowest when both the fellow and the cath lab team were in-hospital (69 min vs. 52 min vs. 40 min) (Figure 2). Conclusions: D2B times may be improved with a 24 hour in-hospital call team. Whether this translates into better clinical outcomes needs to be addressed.
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