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The impact of door-to-electrocardiogram time on door-to-balloon time after achieving the guideline-recommended target rate


Autoři: 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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