Emergency Department Activation of an Interventional Cardiology Team Reduces Door-to-Balloon Times in ST-Segment-Elevation Myocardial Infarction

Singer, Adam J.; Shembekar, Amit; Visram, Farid; Schiller, Joshua; Russo, Valerie; Lawson, William; Gomes, Carol; Santora, Carolyn; Maliszewski, Mary; Wilbert, Lisa; Dowdy, Eileen; Viccellio, Peter; Henry, Mark C.

doi:10.1016/j.annemergmed.2007.06.480

Cited by 33 publications

(25 citation statements)

References 27 publications

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“…662,663 Twelve studies demonstrated that emergency physician activation of the catheterization laboratory was associated with significant reductions in door-to-balloon time intervals (20 to 68 minutes) (LOE 2 664 -666 ; LOE 3 [667][668][669][670][671][672][673] ; LOE 5 663,674 ). Falsepositive activation rate in these studies ranged from 0% to 15%.…”

Section: Consensus On Science Emergency Physician or Prehospital Actimentioning

confidence: 99%

“…Falsepositive activation rate in these studies ranged from 0% to 15%. 674,[663][664][665][666][667][668][669][670][671][672][673] Prehospital Activation of the Catheterization Laboratory. Seven studies demonstrated the effectiveness of prehospital activation on reducing door-to-balloon time intervals (22 to 69 minutes) (LOE 2 656,675 ; LOE 3 676,677 ; LOE 4 660,678 ).…”

Section: Consensus On Science Emergency Physician or Prehospital Actimentioning

confidence: 99%

See 1 more Smart Citation

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

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Section: Consensus On Science Emergency Physician or Prehospital Actimentioning

confidence: 99%

Section: Consensus On Science Emergency Physician or Prehospital Actimentioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

View full text Add to dashboard Cite

show abstract

“…Thus, we decided to use the strategy of direct emergency physician activation of the catheterization laboratory without interventional cardiologist notification, which has been shown to improve DBTs. [13][14][15][16][17][18][19] Our prior protocol also required multiple sequential telephone calls, including calls from the emergency department to the interventional cardiologist, and then from the interventional cardiologist to the emergency department and catheterization laboratory staff. It was evident that a single phone call to the operator would allow for a more streamlined system in catheterization laboratory activation, as reported by others.…”

Section: Design Of the Initiativementioning

confidence: 99%

“…In March 2007, we implemented 4 proven strategies to reduce DBT in our STEMI protocol, including (1) emergency department physician activation of the catheterization laboratory, [13][14][15][16][17][18][19] (2) "single call" broadcast paging of the STEMI team by the page operator, 14 -16 (3) immediate feedback to the emergency and cardiology departments after joint monthly quality improvement meetings to review every STEMI case, 14 -16 and (4) transfer of the off-hours STEMI patients directly to the laboratory on activation. 13 Direct activation of the catheterization laboratory by the emergency department required extensive teaching of emergency medicine nurses and physicians.…”

Section: Implementation Of the Initiativementioning

confidence: 99%

Systems-Based Improvement in Door-to-Balloon Times at a Large Urban Teaching Hospital

Parikh

Treichler²,

DePaola

et al. 2009

Circ: Cardiovascular Quality and Outcomes

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Background-Timely reperfusion in ST-segment elevation myocardial infarction (STEMI) patients improves clinicaloutcomes. Implementing strategies to target institutional-specific delays are crucial for improved patient care. Methods and Results-Using a novel strategy to analyze specific components of door-to-balloon time (DBT) at our institution, we previously identified several specific interval delays in our prior STEMI protocol. We then implemented 4 strategies to reduce DBT: (1) emergency department physician activation of the STEMI protocol; (2) "single call" broadcast paging of the STEMI team by the page operator; (3) immediate feedback to the emergency and cardiology departments with joint monthly quality improvement meetings; and (4)

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“…In fact, it has been shown that treatment delays, even within the hospital, are associated with increased mortality and morbidity (16). Although the identification of factors affecting treatment times and methods to eliminate or minimize these treatment delays remains a major area of AMI research, most investigations have only focused on ways to decrease the door- to-balloon time (17)(18)(19)(20). As a result, door-to-balloon times have decreased from 120 minutes to 90 minutes (12).…”

Section: Discussionmentioning

confidence: 99%

Impact of emergency services and ambulance type on pain-to-balloon time in the acute myocardial infarction: an observational study

Karabulut¹,

Cakmak²,

Uzunlar³

et al. 2012

Anadolu Kardiyol Derg

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Objective: The objective of this study was to evaluate the role of first contact emergency departments and ambulances on transport duration, pain-to-balloon time, door-to-balloon time and first contact-to-balloon time in acute myocardial infarction (AMI) patients. Methods: The study was a prospective and observational investigation. A total of 374 AMI patients initially admitted to primary coronary intervention (PCI) incapable centers were included in this study. Patients were classified according to initial presentation site (daily clinic, public hospital or private hospital) and transport manner (public or private ambulance). All groups were compared by the Kruskal-Wallis and MannWhitney U tests statistically according to their characteristics, transport duration and pain-to-balloon time.Results: A majority of the patients were initially admitted to public (40.1%) or private hospitals (47.1%). The average door-to-balloon time was 45.0±18.5 min and the mean pain-to-balloon time was 310.6±160.8 min. Nearly half of the patients initially admitted to daily clinics were first transported to PCI-incapable centers, leading to delayed admission to PCI-capable centers and increased pain-to-balloon and first contact-toballoon times (361.7±194.5 min, p=0.01 and 279.7±158.2 min, p<0.001). Patients admitted to private hospitals experienced shorter average painto-balloon and first contact-to-balloon times (277.5±148.6 min, p=0.01 and 157.4±83.1 min, p<0.001). Patients transported by private ambulances also experienced shorter waiting times and shorter pain-to-balloon times (107.4±70.4 and 270.1±150.4 min, p<0.001). Conclusion: Physicians and healthcare professionals in first contact emergency departments and ambulance type appear to be factors in the increased pain-to-balloon time. AMI patients are often initially admitted to PCI-incapable centers, leading to delayed admission to PCI-capable centers and increased pain-to-balloon time. (Anadolu Kardiyol Derg 2012; 12: 23-9) Key words: Emergency services, ambulance, pain-to-balloon time 23ÖZET Amaç: Bu çalışma ileriye dönük gözlemsel bir araştırma olup; akut miyokart enfarktüslü (AME) hastalarında, ilk başvurulan acil servis ile ambulans tipinin hasta nakil süresi, ağrı-balon zamanı, kapı-balon süresi ve ilk kontak-balon süresi üzerindeki etkilerini araştırmayı amaçladık. Yöntemler: İlk olarak primer koroner girişim (PKG) imkânı olmayan hastanelere başvuran toplam 374 AMI hastası çalışmaya dâhil edildi. Hastalar ilk başvurdukları merkezlere göre; günlük klinik-tıp merkezi, devlet hastanesi ve özel hastane grubu olarak sınıflandırıldı. Hastalar aynı zamanda nakil sırasında kullanılan ambulans tipine göre de 112 ambulansı veya özel ambulans olarak iki grupta sınıflandırıldı. Tüm gruplar Kruskal-Wallis ve Mann-Whitney U testleri ile istatistiksel olarak demografik özellikler, nakil süresi ve ağrı-balon zamanına göre karşılaştırıldı. Bulgular: Hastaların çoğunluğu ilk olarak devlet hastanesi veya özel hastaneye başvurmuştu (40.1% ve 47.1%). Ortalama kapı-balon süresi 45.0...

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Emergency Department Activation of an Interventional Cardiology Team Reduces Door-to-Balloon Times in ST-Segment-Elevation Myocardial Infarction

Cited by 33 publications

References 27 publications

Part 9: Acute Coronary Syndromes

Part 9: Acute Coronary Syndromes

Systems-Based Improvement in Door-to-Balloon Times at a Large Urban Teaching Hospital

Impact of emergency services and ambulance type on pain-to-balloon time in the acute myocardial infarction: an observational study

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