The impact of door-to-electrocardiogram time on door-to-balloon time after achieving the guideline-recommended target rate
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Chih-Kuo Lee aff001; Shih-Wei Meng aff001; Ming-Hsien Lee aff002; Hsiu-Chi Chen aff002; Chia-Ling Wang aff002; Hui-Ning Wang aff003; Min-Tsun Liao aff001; Mu-Yang Hsieh aff001; Yung-Chung Huang aff005; Edward Pei-Chuan Huang aff006; Chih-Cheng Wu aff004
Působiště autorů:
Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
aff001; Department of Nursing, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
aff002; Quality Control Center, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
aff003; College of Medicine, National Taiwan University, Taipei, Taiwan
aff004; Department of Emergency, Taipei City Hospital, Renai Branch, Taipei, Taiwan
aff005; Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
aff006; Cardiovascular Center, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
aff007; Institute of Biomedical Engineering, National Tsing-Hwa University, Hsinchu, Taiwan
aff008; Institute of Cellular and System Medicine, National Health Research Institute, Miaoli, Taiwan
aff009
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0222019
Souhrn
Background
Little is known about the components and contributing factors of door-to-balloon time after implementation of Door-to-Balloon Alliance quality-improving (QI) strategies, including the impact of door-to-ECG time on door-to-balloon time.
Objective
We investigated whether modification of emergency department (ED) triage processes could improve door-to-ECG and door-to-balloon times after implementation of QI strategies.
Methods
This was a retrospective before-and-after study of a prospectively collected database. From June 2014 to October 2014, interventions were implemented in our ED, including a protocol-driven ECG initiation and moving an ECG station and technician to the triage area. The primary outcome was the percentage of patients with ST-elevation myocardial infarction (STEMI) who received ECG within 10 min of arrival; the secondary outcome was the percentage of patients with door-to-balloon times of <90 min from arrival. Patients from the year pre- and post-QI initiative were defined as the control and intervention groups, respectively.
Results
Enrollment comprised 214 patients with STEMI: 109 before the intervention and 105 after the intervention. We analyzed the components of the door-to-balloon process and found the door-to-ECG process was the most critical interval of delay (20.8%). Unrecognized symptoms were the most common cause of delay in the door-to-ECG process resulting in a significant impact on the door-to-balloon time. The intervention group had a higher percentage of patients with door-to-ECG times <10 min than did the control group (93.3% vs. 79.8%, p = 0.005), with a corresponding improvement in door-to-balloon times <90 min (91.1% vs. 76.2%, p = 0.007). In subgroup analysis, the intervention benefits occurred only in non-transferred or walk-in patients. After adjustment for possible co-variates, the QI interventions remained a significant contributing factor for achieving the door-to-ECG and door-to-balloon targets.
Conclusions
The modification of ED triage processes through implementation of QI strategies are effective in achieving better door-to-ECG times and thus, achieving door-to-balloon times <90 min. In patients presenting with ambiguous symptoms, improved door-to ECG target achievement rates, through a protocol-driven and multidisciplinary approach allows for earlier identification of STEMI.
Klíčová slova:
Research and analysis methods – Bioassays and physiological analysis – Electrophysiological techniques – Cardiac electrophysiology – Electrocardiography – Medicine and health sciences – Critical care and emergency medicine – Resuscitation – Health care – Health care providers – Nurses – Vascular medicine – Coronary heart disease – Cardiology – People and places – Population groupings – Professions – Medical personnel – Technicians – Engineering and technology – Transportation – Ambulances – Science policy – Science and technology workforce – Careers in research
Zdroje
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