The effect of interhospital transfers, emergency medical services, and distance on ischemic time in a rural ST-elevation myocardial infarction system of care

Langabeer, James R.; Prasad, Sapna; Seo, Munseok; Smith, Derek T.; Segrest, Wendy; Owan, Theophilus; Gerard, Daniela; Eisenhauer, Michael D.

doi:10.1016/j.ajem.2015.04.009

Cited by 9 publications

(11 citation statements)

References 6 publications

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“…EMS transit times in regional settings such as Geelong are subject to unique factors, including higher rates of inter‐hospital transfer, greater geographical catchment areas and the use of volunteer EMS 12 . Unfortunately, there is a paucity of research quantifying stroke workflow transfer times in regional health systems.…”

Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy for emergent large vessel occlusion: an Australian primary stroke centre workflow analysis

Tiu

Watson

Clissold

2021

Internal Medicine Journal

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Background Time to successful reperfusion is a critical prognostic factor for acute ischaemic stroke. Mechanical thrombectomy has become the gold standard treatment for emergent large vessel occlusion stroke. The timely delivery of this highly specialised procedure to patients outside of metropolitan centres presents a dilemma of inequity, with limited workflow data hindering benchmarking and service optimisation. Aims To analyse key stroke treatment time parameters from a primary stroke centre existing in a regional centre within a hub‐and‐spoke delivery model in Victoria, Australia. Methods Retrospective cohort study of patients transferred from a regional primary stroke centre to a metropolitan comprehensive stroke centre for mechanical thrombectomy between July 2016 and December 2018. Time workflow analysis was conducted from symptom onset to primary stroke centre departure. Results A total of 55 patients was included in this study with an average age of 70.2 years. Median National Institutes of Health Stroke Scale score on admission was 13 (interquartile range (IQR) 7–17). Median pre‐hospital time was 68 min (IQR 56–137) and median door‐in‐door‐out time was 120.5 min (IQR 98–150), constituting 36.1% and 63.9% of total median time from symptom onset to primary stroke centre departure (188.5 min) respectively. There were no significant differences across observed cohort characteristics under linear regression analysis. Conclusion Protracted pre‐hospital and primary stroke centre workflow times can delay effective treatment for patients with acute ischaemic stroke in regional areas. A systems‐level approach to streamlining processes in these key areas is required to bridge this inequity in best practice care.

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Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy for emergent large vessel occlusion: an Australian primary stroke centre workflow analysis

Tiu

Watson

Clissold

2021

Internal Medicine Journal

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“…As other studies have shown, if users have problems with the system, they cannot work properly with that system, and that all the goals of the system cannot be fully achieved [ 26 , 27 ]. Considering the importance of the EMS in health care system and its impact on patients, many studies have been conducted in various fields such as cardiovascular disease and the EMS [ 28 – 30 ].Also, due to the importance of the EMS users' impact on the realization of patient care goals, studies were done also to identification of factors affecting the readiness of emergency technicians [ 31 ], the impact of work in the EMS on the family [ 32 ] and stressors in emergency technicians [ 33 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of the emergency medical services (EMS) automation system on patient care process and user workflow

Afzali

Jahani

Bagheri

et al. 2021

BMC Med Inform Decis Mak

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Background One of the important components of the health system is the emergency medical services (EMS) system. The EMS system was implemented at Kerman University of Medical Sciences teaching hospitals to communicate the situation of patients being transferred to the hospital by EMS and to provide facilities tailored to the patient's condition. The objective of this study was to investigate the impact of the EMS system on the patient care process and the workflow of users. Methods The hospital information system (HIS) report was used to investigate the impact of the EMS system on the patient care process and a questionnaire was distributed among 244 participants to determine its impact on the workflow of the users. Mann–Whitney U was used to analyze HIS reports, and Chi-square was used to analyze the data collected by questionnaires. Results The EMS system reduced the patient's stay in hospital by an average of 3 h and 45 min. It also increased the number of patients' discharge from the emergency room to 2.2% and reduced the death rate by 1.3% (p < 0.001). Besides, 78% of physicians, 75% of nurses and 83% of technicians stated that this system has positively influenced their workflow. Conclusions The EMS system reduced the patient's stay in hospital and mortality, and increased the speed of patient service, readiness of users to provide patient care and the number of discharged patients. However, problems such as inappropriate technical infrastructure of the EMS system should be solved to improve patients' recovery, reduce mortality and improve user satisfaction.

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“…However, the implementation of air ambulances are often tested in austere and unfamiliar situations [2][3][4][5][6][7], using limited and costly resources [8][9][10][11], and inequity of time [12,13], distance [13][14][15], and accessibility [16][17][18][19]. Similar themes have emerged in multiple regions and countries (2:6, 8, 10:13).…”

Section: Introductionmentioning

confidence: 99%

“…Similar themes have emerged in multiple regions and countries (2:6, 8, 10:13). These developments of improved neurologic, cardiac, and trauma care pathways aim to reduce inequalities and ineffective efforts [8,[11][12][13]18]. The increased utilization of air ambulance retrieval and transfers shows no sign of slowing [20,21] which impacts on an already burdened emergency care system [22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Air ambulance outcome measures using Institutes of Medicine and Donabedian quality frameworks: protocol for a systematic scoping review

et al. 2020

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Background: Dedicated air ambulance services provide a vital link for critically ill and injured patients to higher levels of care. The recent developments of pre-hospital and retrieval medicine create an opportunity for air ambulance providers and policy-makers to utilize a dashboard of quality performance measures to assess service performance. The objective of this scoping systematic review will be to identify and evaluate the range of air ambulance outcome measures reported in the literature and help to construct a quality dashboard based on a healthcare quality framework. Methods: We will search PubMed, MEDLINE, CINAHL, Scopus, and Cochrane Database of Systematic Reviews (from January 2001 onwards). Complementary searches will be conducted in selected relevant journals. We will include systematic reviews and observational studies (cohort, cross-sectional, interrupted time series) in critically ill or injured patients published in English and focusing on air ambulance delivery and quality measures. Two reviewers will independently screen all citations, full-text articles, and abstract data. The study methodological quality (or bias) will be appraised using appropriate tools. Analysis of the characteristics associated with outcome measure will be mapped and described according to the proposed healthcare quality framework. Discussion: This review will contribute to the development of an air ambulance quality dashboard designed to combine multiple quality frameworks. Our findings will provide a basis for helping decision-making in health planning and policy. Systematic review registration: PROSPERO CRD42019144652

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The effect of interhospital transfers, emergency medical services, and distance on ischemic time in a rural ST-elevation myocardial infarction system of care

Cited by 9 publications

References 6 publications

Mechanical thrombectomy for emergent large vessel occlusion: an Australian primary stroke centre workflow analysis

Mechanical thrombectomy for emergent large vessel occlusion: an Australian primary stroke centre workflow analysis

The impact of the emergency medical services (EMS) automation system on patient care process and user workflow

Air ambulance outcome measures using Institutes of Medicine and Donabedian quality frameworks: protocol for a systematic scoping review

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