Door-to-Balloon Times from Freestanding Emergency Departments Meet ST-Segment Elevation Myocardial Infarction Reperfusion Guidelines

Acuity, outcomes, and trends in the transfer of surgical patients: a national study

“…However, for any surgical evaluation, freestanding EDs must transfer patients to an acute care facility or emergency room. In a recent study, 32 % of patients with a STelevation myocardial infarction transferred from a freestanding ED to definitive care had a door-to-balloon time that exceeded the American Heart Association's recommended guideline of less than 90 min (median 83 min, interquartile range ± 10.3 min) [39]. Conscious efforts must be undertaken to reduce the morbidity of transfer when expanding hospital networks and the use of freestanding EDs; more research is needed to understand the impact of these trends.…”

Freestanding Emergency Departments: What Is Their Role in Emergency Care?

“…Simon et al 33 found that at 2 freestanding EDs, only 78.7% of patients receiving a diagnosis of ST-segment elevation myocardial infarction met the American Heart Association's recommended door-to-balloon time (less than 90 minutes) between 2007 and 2012. That percentage was lower than that found by Krumholz et al 34 when they investigated all acute myocardial infarction patients reported by hospitals to CMS.…”

“…One criticism of the article by Simon et al, 33 however, could be that freestanding ED patients with ST-segment elevation myocardial infarction would be better categorized as transfer patients, and 2013 American Heart Association guidelines for transfer patients with ST-segment elevation myocardial infarction are doorto-balloon times less than 120 minutes. 35 This 120-minute metric was not measured in the study by Simon et al 33 In another study comparing patients admitted to the ICU from either a hospital-based ED or an associated freestanding ED, Simon et al 27 found that patients admitted from a freestanding ED had a significantly shorter inhospital length of stay, with a mean of 5 days compared with 7 days for patients admitted from the hospital-based ED. This may reflect better initial care at freestanding EDs or it may simply reflect the lower severity of cases treated at freestanding EDs compared with hospital-based EDs.…”

Should freestanding emergency departments be considered in Australia?

“…Research involving eight academic FSEDs has shown that they achieved higher patient satisfaction scores than national averages, lower rates of 'left without being seen' patients and very low rates of 'left against medical advice' patients. 37 Any delays to definitive care can affect quality. 15,35,36 Patient safety As FSEDs are located outside acute care hospitals concerns may arise about patient safety.…”

“…11 It has been shown that FSEDs can meet the door to balloon time metric. 37 Any delays to definitive care can affect quality. Agreed local FSED bypass rules regarding patients who are likely to require complex definitive care should be in place.…”