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
prolekare.web.journal.doi_sk:
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:
Engineering and technology – Research and analysis methods – People and places – Population groupings – Professions – Medicine and health sciences – Critical care and emergency medicine – Resuscitation – Health care – Health care providers – Nurses – Medical personnel – Transportation – Vascular medicine – Cardiology – Bioassays and physiological analysis – Electrophysiological techniques – Cardiac electrophysiology – Electrocardiography – Coronary heart disease – Technicians – Ambulances – Science policy – Science and technology workforce – Careers in research
Zdroje
1. Kastrati A, Caforio ALP, Bucciarelli-Ducci C, Varenhorst C, Prescott E, Crea F, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal. 2017;39(2):119–77. doi: 10.1093/eurheartj/ehx393 28886621
2. Antman Elliott M, Anbe Daniel T, Armstrong Paul W, Bates Eric R, Green Lee A, Hand Mary et al. ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary. Circulation. 2004;110(5):588–636.
3. Jneid H, Addison D, Bhatt DL, Fonarow GC, Gokak S, Grady KL, et al. 2017 AHA/ACC Clinical Performance and Quality Measures for Adults With ST-Elevation and Non–ST-Elevation Myocardial Infarction. A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. 2017;70(16):2048–90.
4. Bradley EH, Herrin J, Wang Y, Barton BA, Webster TR, Mattera JA, et al. Strategies for Reducing the Door-to-Balloon Time in Acute Myocardial Infarction. New England Journal of Medicine. 2006;355(22):2308–20. doi: 10.1056/NEJMsa063117 17101617.
5. Krumholz HM, Bradley EH, Nallamothu BK, Ting HH, Batchelor WB, Kline-Rogers E, et al. A campaign to improve the timeliness of primary percutaneous coronary intervention: Door-to-Balloon: An Alliance for Quality. JACC Cardiovascular interventions. 2008;1(1):97–104. Epub 2008/02/01. doi: 10.1016/j.jcin.2007.10.006 19393152.
6. Bradley EH, Nallamothu BK, Herrin J, Ting HH, Stern AF, Nembhard IM, et al. National Efforts to Improve Door-to-Balloon Time: Results From the Door-to-Balloon Alliance. Journal of the American College of Cardiology. 2009;54(25):2423–9. https://doi.org/10.1016/j.jacc.2009.11.003. 20082933
7. Wu CK, Juang JJ, Chiang JY, Li YH, Tsai CT, Chiang FT. The Taiwan Heart Registries: Its Influence on Cardiovascular Patient Care. J Am Coll Cardiol. 2018;71(11):1273–83. Epub 2018/03/17. doi: 10.1016/j.jacc.2018.02.006 29544612.
8. Ikemura N, Sawano M, Shiraishi Y, Ueda I, Miyata H, Numasawa Y, et al. Barriers Associated With Door-to-Balloon Delay in Contemporary Japanese Practice. Circulation journal: official journal of the Japanese Circulation Society. 2017;81(6):815–22. Epub 2017/02/24. doi: 10.1253/circj.CJ-16-0905 28228609.
9. Ho AF, Loy EY, Pek PP, Wah W, Tan TX, Liu N, et al. Emergency Medical Services Utilization among Patients with ST-Segment Elevation Myocardial Infarction: Observations from the Singapore Myocardial Infarction Registry. Prehospital emergency care: official journal of the National Association of EMS Physicians and the National Association of State EMS Directors. 2016;20(4):454–61. Epub 2016/03/18. doi: 10.3109/10903127.2015.1128032 26986553.
10. Menees DS, Peterson ED, Wang Y, Curtis JP, Messenger JC, Rumsfeld JS, et al. Door-to-Balloon Time and Mortality among Patients Undergoing Primary PCI. New England Journal of Medicine. 2013;369(10):901–9. doi: 10.1056/NEJMoa1208200 24004117.
11. Li YH, Wang YC, Wang YC, Liu JC, Lee CH, Chen CC, et al. 2018 Guidelines of the Taiwan Society of Cardiology, Taiwan Society of Emergency Medicine and Taiwan Society of Cardiovascular Interventions for the management of non ST-segment elevation acute coronary syndrome. Journal of the Formosan Medical Association = Taiwan yi zhi. 2018;117(9):766–90. Epub 2018/07/19. doi: 10.1016/j.jfma.2018.06.002 30017533.
12. Phelan MP, Glauser J, Smith E, Martin C, Schrump S, Mahone P, et al. Improving emergency department door-to-electrocardiogram time in ST segment elevation myocardial infarction. Critical pathways in cardiology. 2009;8(3):119–21. Epub 2009/09/04. doi: 10.1097/HPC.0b013e3181b5a6f3 19726931.
13. Purim-Shem-Tov YA, Rumoro DP, Veloso J, Zettinger K. Emergency Department greeters reduce door-to-ECG time. Critical pathways in cardiology. 2007;6(4):165–8. Epub 2007/12/20. doi: 10.1097/HPC.0b013e31815b565d 18091406.
14. Takakuwa KM, Burek GA, Estepa AT, Shofer FS. A method for improving arrival-to-electrocardiogram time in emergency department chest pain patients and the effect on door-to-balloon time for ST-segment elevation myocardial infarction. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine. 2009;16(10):921–7. Epub 2009/09/17. doi: 10.1111/j.1553-2712.2009.00493.x 19754862.
15. Coyne CJ, Testa N, Desai S, Lagrone J, Chang R, Zheng L, et al. Improving door-to-balloon time by decreasing door-to-ECG time for walk-in STEMI patients. The western journal of emergency medicine. 2015;16(1):184–9. Epub 12/09. doi: 10.5811/westjem.2014.10.23277 25671039.
16. Bradley EH, Nallamothu BK, Stern AF, Cherlin EJ, Wang Y, Byrd JR, et al. The door-to-balloon alliance for quality: who joins national collaborative efforts and why? Joint Commission journal on quality and patient safety. 2009;35(2):93–9. 19241729.
17. Parikh Shailja V, Treichler DB, DePaola S, Sharpe J, Valdes M, Addo T, et al. Systems-Based Improvement in Door-to-Balloon Times at a Large Urban Teaching Hospital. Circulation: Cardiovascular Quality and Outcomes. 2009;2(2):116–22. doi: 10.1161/CIRCOUTCOMES.108.820134 20031823
18. McCabe JM, Armstrong EJ, Hoffmayer KS, Bhave PD, MacGregor JS, Hsue P, et al. Impact of door-to-activation time on door-to-balloon time in primary percutaneous coronary intervention for ST-segment elevation myocardial infarctions: a report from the Activate-SF registry. Circulation Cardiovascular quality and outcomes. 2012;5(5):672–9. Epub 2012/09/06. doi: 10.1161/CIRCOUTCOMES.112.966382 22949494.
19. Wu EB, Arora N, Eisenhauer AC, Resnic FS. An analysis of door-to-balloon time in a single center to determine causes of delay and possibilities for improvement. Catheterization and Cardiovascular Interventions. 2008;71(2):152–7. doi: 10.1002/ccd.21315 17985378
20. Miedema MD, Newell MC, Duval S, Garberich RF, Handran CB, Larson DM, et al. Causes of delay and associated mortality in patients transferred with ST-segment-elevation myocardial infarction. Circulation. 2011;124(15):1636–44. Epub 2011/09/21. doi: 10.1161/CIRCULATIONAHA.111.033118 21931079.
21. Sim WJ, Ang AS, Tan MC, Xiang WW, Foo D, Loh KK, et al. Causes of delay in door-to-balloon time in south-east Asian patients undergoing primary percutaneous coronary intervention. PLOS ONE. 2017;12(9):e0185186. doi: 10.1371/journal.pone.0185186 28934306
22. Eiselt J, Racek J, Opatrny K Jr., Trefil L, Stehlik P. The effect of intravenous iron on oxidative stress in hemodialysis patients at various levels of vitamin C. Blood purification. 2006;24(5–6):531–7. Epub 2006/11/02. doi: 10.1159/000096474 17077626
23. Graff L, Palmer AC, LaMonica P, Wolf S. Triage of patients for a rapid (5-minute) electrocardiogram: A rule based on presenting chief complaints. Annals of Emergency Medicine. 2000;36(6):554–60. doi: 10.1067/mem.2000.111057 11097694
24. Markel KN, Marion SA. CQI: Improving the time to thrombolytic therapy for patients with acute myocardial infarction in the emergency department. The Journal of Emergency Medicine. 1996;14(6):685–9. https://doi.org/10.1016/S0736-4679(96)00184-9. 8969986
25. Zarich SW, Sachdeva R, Fishman R, Werd A, Michael J., Parniawski M, et al. Effectiveness of a Multidisciplinary Quality Improvement Initiative in Reducing Door-to-Balloon Times in Primary Angioplasty. Journal of Interventional Cardiology. 2004;17(4):191–5. doi: 10.1111/j.1540-8183.2004.00383.x 15318889
26. Ho AF, Fook-Chong S, Pek PP, Ng YY, Wong AS, Ong ME. Prehospital presentation of patients with ST-segment elevation myocardial infarction in Singapore. International journal of cardiology. 2013;168(4):4273–6. Epub 2013/05/25. doi: 10.1016/j.ijcard.2013.04.204 23701931.
27. Wah W, Pek PP, Ho AF, Fook-Chong S, Zheng H, Loy EY, et al. Symptom-to-door delay among patients with ST-segment elevation myocardial infarction in Singapore. Emerg Med Australas. 2017;29(1):24–32. doi: 10.1111/1742-6723.12689 27728959
28. Ho AF, Pek PP, Fook-Chong S, Wong TH, Ng YY, Wong AS, et al. Prehospital system delay in patients with ST-segment elevation myocardial infarction in Singapore. World J Emerg Med. 2015;6(4):277–82. doi: 10.5847/wjem.j.1920-8642.2015.04.005 26693262
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