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

Abstract

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.

A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients

“…Sixteen studies reported on paramedic actions for trauma, stroke and MI patients that were in addition to standard handover [ 24 – 39 ]. They did not directly provide patient care, and the paramedic role was restricted to prehospital activation [ 25 , 37 ] or transportation of patients to condition-specific specialist facilities such as catheterisation laboratory for MI patients [ 26 , 28 , 30 – 33 , 38 ], radiology for acute stroke patients [ 24 , 27 , 34 , 36 , 39 ], radiology for trauma (hip fracture) patients [ 35 ], or a pacing centre for patients with complete heart block [ 29 ]. In one study paramedics were also responsible for delivery of blood test results of trauma (hip fracture) patients to the hospital laboratory [ 35 ].…”

Factors Influencing Time to First Medical Contact in Patients with Acute ST-Segment Elevation Myocardial Infarction: A Retrospective Analysis

“…Compared with metropolitan Italian data, EMS bypassing the emergency department and early triage based on electrocardiogram can significantly reduce system delays. When EMS bypasses the high proportion of emergency visits, reducing decision time alone can lead to further reduced system delays [ 27 ]. With the publicity and popularization of acute myocardial infarction-related knowledge, at this stage, with citizens having a greater understanding of the discriminatory symptoms of acute myocardial infarction, the focus should be on promoting awareness of the EMS treatment process and its benefits and on reducing total myocardial ischemia time, and improve the prognosis for patients with acute myocardial infarction.…”

Reducing the Wire Crossing Time in Primary Percutaneous Coronary Angioplasty: A Study From a Tier II City in India

“…There are several suggestive measures to reduce the door-to-door time and centers should choose one or more based on local considerations. Some of these strategies require investment in infrastructure such as providing prehospital ECGs, while some others can be applied in most hospitals, with limited budgets, by modifying the internal protocols such as the activation of the STEMI code by emergency physicians and the direct transfer of patients to the cath lab, bypassing the ER [17][18][19][20][21].…”