Factors Influencing Time-Dependent Quality Indicators for Patients With Suspected Acute Coronary Syndrome

Abstract

Objectives Rapid risk stratification and timely treatment are critical to favorable outcomes for acute coronary syndrome (ACS) patients. Our objective was to identify patient and system factors that influence time-dependent quality indicators (QIs) for unstable angina (UA)/non-ST elevation Myocardial Infarction (NSTEMI) patients in the emergency department (ED). Methods A retrospective, cohort study was conducted over a 42-month period of all patients aged 24 years or older suspected of having ACS as defined by receiving an electrocardiogram (ECG) and at least one cardiac biomarker test. Cox regression was used to model the effects of patient characteristics, ancillary service utilization, staffing provisions, equipment availability and ED and hospital crowding on ACS QIs. Results ED adherence rates to national standards for ECG read out time and biomarker turn-around-time were 42% and 37%, respectively. Cox regression models revealed that chief complaints without chest pain and the timing of stress testing and medication administration were associated with the most significant delays. Conclusions Patient and system factors both significantly influenced QI times in this UA/NSTEMI cohort. These results illustrate both the complexity of diagnosing NSTEMI patients and the competing effects of clinical and system factors on patient flow through the ED.

Retrospective review of non-ST segment elevation acute coronary syndrome presenting to the emergency department of a major tertiary center in Saudi Arabia

“… 38 Factors such as age<65, female gender, non-white race, non-English language, and insurance type have been determined as the cause of significant delays in time intervals in more than one study. 4 , 43 Generally, patients who receive a higher Canadian Triage and Acuity Scale (CTAS) triage category in the ED have shorter travel times, as clinicians will prioritize those patients. Yoon et al found that NSTEMI-ACS patients with lower triage categories had the longest wait times for physicians and nurses and the longest ED length of stay (LOS).…”

“… 1 In the United States, chest pain accounts for about 8 million adult visits to the ED, becoming the second most frequent cause of emergency department (ED) visits after abdominal pain. 2 – 4 Cardiovascular disease incidence is increasing in developing countries over the last decade. 5 , 6 …”

“…Despite several studies indicative of adherence to the AHA/ACS guideline, ED physicians still struggle to fulfill these criteria. 4 , 20 …”

Challenges and Burdens in the Coronary Artery Disease Care Pathway for Patients Undergoing Percutaneous Coronary Intervention: A Contemporary Narrative Review

“…In patients with acute CAD, the timely delivery of care is critical for favorable outcomes [38]. Current practice guidelines recommend that patients receive an ECG within 10 min of presenting to an emergency department [39,40].…”

“…However, accessing emergent diagnostic care in ACS is often delayed due to several factors, such as suboptimal patient flow and access to appropriate technologies. A real-world analysis in U.S. adults with ACS revealed that emergency department adherence rates to national standards for arrival time-to-ECG read-out time and physician-ordered biomarker turnaround-time were only 42 and 37%, respectively, with delays related to patient complaints inconsistent with ACS, the timing of stress testing, and medication administration [38]. In Europe, specialized chest pain units (CPUs), compared to emergency departments, may improve access to care for patients with ACS.…”