False activation of the cardiac catheterization laboratory: The price to pay for shorter treatment delay

Abstract

Introduction In patients with acute ST elevation myocardial ischemia (STEMI), national efforts have focused on reducing door-to-balloon (D2B) times for primary percutaneous coronary intervention (PCI). This emphasis on time-to-treatment may increase the rate of inappropriate cardiac catheterization laboratory (CCL) activations and unnecessary healthcare utilization. To achieve lower D2B times, community hospitals and EMS systems have enabled emergency medical technicians (EMTs) and emergency department (ED) physicians to activate the CCLs without immediately consulting a cardiologist. Objective The purpose of this study is to determine the rate and main causes of inappropriate activation of the CCL which will aid in finding solutions to reduce this occurrence. Method This is a retrospective study, based on an electronic medical system review of all inappropriate CCL activation who presented to Providence Hospital and Medical Centers (PHMC) in Michigan, from January 2015 to July 2016. Results The CCL was activated 375 times for suspected STEMI. The false STEMI activation was identified in 47 patients which represents 12.5% of total CCL activation. The vast majority of this false activation was due to non-diagnostic electrocardiogram (ECG) that did not meet the STEMI criteria. Conclusion The subjective interpretation of the ECG by EMTs and ED physicians tend to show a wide variability, which may lead to higher-than-anticipated false activation rates of up to 36% in one study. Some studies had reported that up to 72% of inappropriate activations were caused by ECG misinterpretations. These false activations have ramifications that lead to both clinical and financial costs.

Systems of Care in Cardiogenic Shock

“…With less stringent activation criteria, a high incidence of false calls and inappropriate use of resources can lead to increased costs and compromise the program's sustainability. This effect has been studied previously in STEMI systems (43). A tiered activation model, where cases are first filtered through an on-call intensivist or HF specialist as seen in the Utah experience after hours and with the Canadian shock team during all activations, could limit resource exhaustion (29,39).…”

The Effectiveness of the Smartphone-Based WeChat Platform on Reducing Time to Diagnosis and Treatment of ST-segment Elevation Myocardial Infarction

“…Over the past few decades, the implementation of a number of essential strategies that target system delays has resulted in significantly improved management of STEMI patients. These strategies include the acquisition of a pre-hospital electrocardiogram (ECG) by emergency medical services, and activation of the cardiac catheterization laboratory (CL) [ 7 , 8 , 9 ]. The latter is essential for lowering the reperfusion time and is related to reduced mortality, but may lead to numerous cancellations due to false activation [ 9 ].…”

Human–Computer Agreement of Electrocardiogram Interpretation for Patients Referred to and Declined for Primary Percutaneous Coronary Intervention: Retrospective Data Analysis Study

“…It is well documented that misinterpretation of the ECG can lead to incorrect decision making regarding treatment, such as false activations (rates of up to 36% [ 14 ]) or patients being declined. According to Degheim et al [ 15 ], 12.5% of all CathLab activations were false activations for misinterpreted ST-elevation myocardial infarction. These false activations have both clinical and financial costs.…”