Satisfaction With Emergent Transfer for Percutaneous Coronary Interventions on Patients With ST–Segment-Elevation Myocardial Infarction and Their Families

Abstract

Background-Transfer for primary percutaneous coronary intervention (PCI) is superior to fibrinolysis if performed in a timely manner but frequently requires dislocation of patients and their families from their local community. Although patient satisfaction is increasingly viewed as an important quality indicator, there are no data on how emergent transfer for PCI affects patients with ST-segment-elevation myocardial infarction and their families. Methods and Results-The Minneapolis Heart Institute's Level 1 Regional ST-Segment-Elevation Myocardial Infarction program is designed to facilitate emergent transfer for PCI in patients with ST-segment-elevation myocardial infarction from 31 rural and community hospitals. To determine the effect of emergent transfer, questionnaires were given to 152 patients and their families who survived to hospital discharge with a 65.8% response rate (mean age, 63.9 years; 29% women). Ninety-five percent of patients felt the reasons and process of transfer were well explained, and 97% felt transfer for care was necessary. Despite this, 15% of patients would have preferred to stay in their local hospital. The majority of the families felt the transfer process (88%) and family member's condition (94%) were well explained. Although 99% felt it was necessary for their family member to be transferred for specialized care, 11% of families still would have preferred that their family members remain at the local community hospital. Conclusions-Our results suggest that ST-segment-elevation myocardial infarction patients and families can be informed, even in time-critical situations, about the transfer process for PCI and understand the need for specialized care. Still, a significant minority would prefer to stay at their local hospital, despite acknowledging transfer for PCI provided optimal care. (Circ Cardiovasc Qual Outcomes. 2014;7:244-250.)Key Words: patient education as topic ◼ quality of health care ◼ ST-elevation myocardial infarction ◼ systems of care

Regional to tertiary inter-hospital transfer versus in-house percutaneous coronary intervention in acute coronary syndrome

“…Our assumption is supported by previous studies which identify financial challenges and the displacement from family as deterrents to inter hospital transfer. [ 32 ] Indeed our results support our hypothesis. Thematic analysis of the comments showed that patients were predominantly satisfied with their interaction with hospital staff and the service provision at the local and tertiary accepting hospitals but were dissatisfied with the extended waiting periods for transfer and treatment.…”

“…Previous data indicates that careful explanation and education is the hallmark of patient satisfaction in the acute setting. [ 32 ] In our study the theme of patient education was greater amongst patients receiving in-house angiography and may have alleviated potential concerns and thereby increased satisfaction. The treatment of ACS however represents a chaotic and stressful event where patient education continues to be a challenge as identified by the American Heart Association.…”

“…Previous data indicate that a proportion of patients prefer to be treated at their local hospital, despite acknowledging that transfer for PCI provides optimal acute care. [ 32 ] Past literature also shows that rural physicians tend to overestimate the patient-perceived value of nonmedical aspects of care, such as the importance of proximity to home, and underestimate the importance of being cared for in a comprehensive medical centre. [ 33 ] Therefore the provision of in-house catheterisation in Mackay represents a unique innovation that simultaneously maximises patient satisfaction whilst improving access to high-level medical care.…”

Access to cardiac catheterization services in a rural-urban setting in northern British Columbia: Examining the impact of time-delay to PCI on patient outcomes and whether the sickest go the quickest..

“…Furthermore, this may be complicated by a number o f other factors external to the health care environment. For example, there may be presentation delay by patients post symptom onset while other patients may be adamant that they wish to receive care at a specific centre based on their prior experience either personally or otherwise (Henry et al, 2014).…”