Impact of an Audit Program and Other Factors on Door‐to‐balloon Times in Acute ST‐elevation Myocardial Infarction Patients Destined for Primary Coronary Intervention

Lai, Chao‐Lun; Fan, Chia‐Ming; Liao, Pen-Chih; Tsai, Kuang-Chau; Yang, Chi-Yu; Chu, Shu‐Hsun; Chien, Kuo–Liong

doi:10.1111/j.1553-2712.2009.00372.x

Cited by 20 publications

(11 citation statements)

References 32 publications

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“…This has been shown not only to shorten delay to treatment but also to improve outcome [193-202]. The training of the staff in hospital and the implementation of guidelines or an audit programme can also reduce the in-hospital delay to treatment in AMI [203-205]. …”

Section: The Reviewmentioning

confidence: 99%

Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities

Herlitz

Wireklint-Sundström

Bång

et al. 2010

Scand J Trauma Resusc Emerg Med

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BackgroundThe two major complications of atherosclerosis are acute myocardial infarction (AMI) and acute ischemic stroke. Both are life-threatening conditions characterised by the abrupt cessation of blood flow to respective organs, resulting in an infarction. Depending on the extent of the infarction, loss of organ function varies considerably.In both conditions, it is possible to limit the extent of infarction with early intervention. In both conditions, minutes count.This article aims to describe differences and similarities with regard to the way patients, bystanders and health care providers act in the acute phase of the two diseases with the emphasis on the pre-hospital phase.MethodA literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases.ResultsIn both conditions, symptoms vary considerably. Patients appear to suspect AMI more frequently than stroke and, in the former, there is a gender gap (men suspect AMI more frequently than women).With regard to detection of AMI and stroke at dispatch centre and in Emergency Medical Service (EMS) there is room for improvement in both conditions. The use of EMS appears to be higher in stroke but the overall delay to hospital admission is shorter in AMI. In both conditions, the fast track concept has been shown to influence the delay to treatment considerably.In terms of diagnostic evaluation by the EMS, more supported instruments are available in AMI than in stroke. Knowledge of the importance of early treatment has been reported to influence delays in both AMI and stroke.ConclusionBoth in AMI and stroke minutes count and therefore the fast track concept has been introduced. Time to treatment still appears to be longer in stroke than in AMI. In the future improvement in the early detection as well as further shortening to start of treatment will be in focus in both conditions. A collaboration between cardiologists and neurologists and also between pre-hospital and in-hospital care might be fruitful.

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Section: The Reviewmentioning

confidence: 99%

Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities

Herlitz

Wireklint-Sundström

Bång

et al. 2010

Scand J Trauma Resusc Emerg Med

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“…We focused on improvement of the more robust and objective system delay time, specifically the time to decision by the cardiologist on call and the time to arrival at the cath-lab. Several strategies that reduce system delay time were used in our study including central evaluation of the ECG14 and real-time data feedback 15. We noted that the regularly given feedback resulted in intense, collaborative discussions among caregivers.…”

Section: Discussionmentioning

confidence: 99%

Strategies TO reduce time delays in patients with AcuTe coronary heart disease treated with primary PCI—the STOP WATCH study: a multistage action research project

et al. 2013

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ObjectiveTo identify, evaluate and reduce system delay times in an ST-elevation myocardial infarction (STEMI) network by targeted reorganisation of logistics and personal feedback to staff on time delays.DesignMultistage action research project. Three study phases were used (exploration, tailored intervention and evaluation).SettingSingle centre study, Sweden.PatientsConsecutive patients (N=156) with prehospital STEMI onset treated with primary percutaneous coronary intervention (PCI).InterventionsAreas of delays were identified through participant observations and collaborative discussions. To increase the awareness of delay factors, continuous feedback on time delays was given. Elements of the logistics’ reorganisation were (1) prioritised ECG recording by emergency medical services personnel, (2) central evaluation of ECG in all patients and (3) start of PCI procedure when two of three PCI team members were on site. Multiple key time measurements were made before (N=67) and after (N=89) the intervention.Main outcomesTime difference (minutes) in system delay between the preintervention and postintervention phases.ResultsTime from first medical contact (FMC) to a patent artery and time from FMC-to-catheter laboratory (cath-lab) arrival decreased by 6 and 12 min, respectively (ns). Time from FMC-to-ECG recording remained unchanged after the intervention. Time from ECG to decision for primary PCI was reduced by 6 min, p=0.004 and time from ECG-to-cath-lab arrival by 11 min, p=0.02. Total time from diagnosis to a patent artery decreased by 11 min (ns).ConclusionsIdentification of time delays in an STEMI network with awareness of delay factors, reorganisation of logistics and continuous feedback can reduce system delay times significantly.

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“…Two separate models were constructed using ED-level and patientlevel composite guideline concordance scores as the outcome measure. Model variables were selected a priori, 25 based on review of the medical literature, 26 or from variables associated with the outcome at p < 0.10 in univariable analyses. 27 For the ED-level analysis, model variables included ED characteristics (number of ED beds, region, and residency affiliation) and aggregate patient mix (age, sex, race ⁄ ethnicity, previous MI, and pulmonary edema).…”

Section: Study Protocolmentioning

confidence: 99%

Quality of Care for Acute Myocardial Infarction in 58 U.S. Emergency Departments

Tsai

Magid

Sullivan

et al. 2010

Academic Emergency Medicine

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Objectives: The objectives of this study were to determine concordance of emergency department (ED) management of acute myocardial infarction (AMI) with guideline recommendations and to identify ED and patient characteristics predictive of higher guideline concordance. Methods:The authors conducted a chart review study of ED AMI care as part of the National Emergency Department Safety Study (NEDSS). Using a primary hospital discharge diagnosis of AMI (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM], codes 410.XX), a random sample of ED visits for AMI in 58 urban EDs across 20 U.S. states between 2003 and 2006 were identified. Concordance with American College of Cardiology ⁄ American Heart Association (ACC ⁄ AHA) guideline recommendations was evaluated using five individual quality measures and a composite concordance score. Concordance scores were calculated as the percentage of eligible patients who received guidelines-recommended care. These percentage scores were rescaled from 0 to 100, with 100 indicating perfect concordance.Results: The cohort consisted of 3,819 subjects; their median age was 65 years, and 62% were men. The mean (± standard deviation [SD]) ED composite concordance score was 61 ± 8), with a broad range of values (42 to 84). Except for aspirin use (mean concordance, 82), ED concordance scores were low (betablocker use, 56; timely electrocardiogram [ECG], 41; timely fibrinolytic therapy, 26; timely ED disposition for primary percutaneous coronary intervention [PCI] candidates, 43). In multivariable analyses, older age (beta-coefficient per 10-year increase, )1.5; 95% confidence interval [CI] = )2.4 to )0.5) and southern EDs (beta-coefficient, )5.2; 95% CI = )9.6 to )0.9) were associated with lower guideline concordance, whereas ST-segment elevation on initial ED ECG was associated with higher guideline concordance (beta-coefficient, 3.6; 95% CI = 1.5 to 5.7).Conclusions: Overall ED concordance with guideline-recommended processes of care was low to moderate. Emergency physicians should continue to work with other stakeholders in AMI care, such as emergency medical services (EMS) and cardiologists, to develop strategies to improve care processes.ACADEMIC EMERGENCY MEDICINE 2010; 17:940-950 ª

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Impact of an Audit Program and Other Factors on Door‐to‐balloon Times in Acute ST‐elevation Myocardial Infarction Patients Destined for Primary Coronary Intervention

Cited by 20 publications

References 32 publications

Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities

Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities

Strategies TO reduce time delays in patients with AcuTe coronary heart disease treated with primary PCI—the STOP WATCH study: a multistage action research project

Quality of Care for Acute Myocardial Infarction in 58 U.S. Emergency Departments

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