Primary Percutaneous Coronary Intervention for Patients Presenting With ST-Segment Elevation Myocardial Infarction: Process Improvement in a Rural ST-Segment Elevation Myocardial Infarction Receiving Center

Niles, Nathaniel W.; Conley, Sheila M.; Yang, Rayson; Vanichakarn, Pantila; Anderson, Tamara A.; Butterly, John R.; Robb, John F.; Jayne, John E.; Yanofsky, Norman N.; Proehl, Jean A.; Guadagni, Donald F.; Brown, Jeremiah R.

doi:10.1016/j.pcad.2010.08.004

Cited by 12 publications

(11 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[11] STEMI care networks in rural areas may have several disadvantages in achieving this benchmark for the following reasons. [20] First, emergency medical systems in rural hospitals usually have lower staffing level of paramedics or emergency medical technicians, which limits the capability of STEMI diagnosis. Second, PCI capabilities in rural hospitals do not have enough resources for 24/7 in-house staffing in the cardiac catheterization laboratory, which results in longer response time to catheterization laboratory activation.…”

Section: Discussionmentioning

confidence: 99%

Current Trends for ST-segment Elevation Myocardial Infarction during the Past 5 Years in Rural Areas of China's Liaoning Province

Zhou

et al. 2017

Chinese Medical Journal

View full text Add to dashboard Cite

Background:Since 2010, two versions of National Guidelines aimed at promoting the management of ST-segment elevation myocardial infarction (STEMI) have been formulated by the Chinese Society of Cardiology. However, little is known about the changes in clinical characteristics, management, and in-hospital outcomes in rural areas.Methods:In the present multicenter, cross-sectional study, participants were enrolled from rural hospitals located in Liaoning province in Northeast China, during two different periods (from June 2009 to June 2010 and from January 2015 to December 2015). Data collection was conducted using a standardized questionnaire. In total, 607 and 637 STEMI patients were recruited in the 2010 and 2015 cohorts, respectively.Results:STEMI patients in rural hospitals were older in the second group (63 years vs. 65 years, P = 0.039). We found increases in the prevalence of hypertension, prior percutaneous coronary intervention (PCI), and prior stroke. Over the past 5 years, the cost during hospitalization almost doubled. The proportion of STEMI patients who underwent emergency reperfusion had significantly increased from 42.34% to 54.47% (P < 0.0001). Concurrently, the proportion of primary PCI increased from 3.62% to 10.52% (P < 0.0001). The past 5 years have also seen marked increases in the use of guideline-recommended drugs and clinical examinations. However, in-hospital mortality and major adverse cardiac events did not significantly change over time (13.01% vs. 10.20%, P = 0.121; 13.34% vs. 13.66%, P = 0.872).Conclusions:Despite the great progress that has been made in guideline-recommended therapies, in-hospital outcomes among rural STEMI patients have not significantly improved. Therefore, there is still substantial room for improvement in the quality of care.

show abstract

Section: Discussionmentioning

confidence: 99%

Current Trends for ST-segment Elevation Myocardial Infarction during the Past 5 Years in Rural Areas of China's Liaoning Province

Zhou

et al. 2017

Chinese Medical Journal

View full text Add to dashboard Cite

show abstract

“…6 While the aforementioned studies focused on transferred patients, a 396-bed referral hospital for STEMI patients located in rural New Hampshire collectively examined arrival of STEMI patients from both the emergency department and the field. 4 After initiating a protocol for rapid triage and transfer of STEMI patients, they reported 77% of patients achieving DTD times below 90 minutes with a median DTD time of 67 minutes (n=79) and a 30-day mortality of 6.7%. Compared to the above published studies, our data showed comparable performance.…”

Section: Discussionmentioning

confidence: 99%

“…In the rural setting, other factors posited for contributing to transfer delays include inadequate staffing of emergency medical services personnel, lack of 24/7 in-house cardiac catheterization laboratory team, effects of weather on transportation, and lack of experience managing STEMI at community hospitals due to relatively infrequent occurrence. 4 Nevertheless, feasibility of achieving DTD times of <90 minutes in rural settings has been demonstrated, both with and without a protocol for rapid triage and transfer. 5,6 The time of day a patient presents with STEMI is an important prognostic factor.…”

mentioning

confidence: 99%

Variability of Door-to-Device Times at a Rural Tertiary Care Center

Abrich

Rokey

Bhupathi

et al. 2014

Clinical Medicine & Research

View full text Add to dashboard Cite

Objectives: Target door-to-device (DTD) time for ST-elevation myocardial infarction (STEMI) patients has been 90 minutes, with no distinction between urban and rural hospitals. Rural hospitals have longer DTD times for transferred patients attributed to long transportation times from referring hospitals. Longer DTD times have also been reported during after-hours. The aim of the study was to determine whether DTD times at our rural facility were impacted by arrival method, arrival time period, and season. Design: Retrospective chart review.Setting: Rural tertiary care center in central Wisconsin. Methods:We studied 412 patients presenting with STEMI after initiation of the Rescue One program for rapid triage and transfer from October 2006 through December 2012. They were subdivided by arrival method, arrival time (ON=Monday-Friday, 8 AM-5 PM; OFF=after-hours, weekends, holidays), and season. Median DTD times and proportions below and above 90 minutes were compared. Results:Median DTD time for all groups, which include both directly admitted and transferred patients, was 85 minutes with 60% of patients achieving DTD times below 90 minutes while 30-day mortality was 5.3%. Median DTD time was 67 minutes for the Emergency Department (ED) (n=164), 95 minutes for Transfers (n=204), 68 minutes for Urgent Care (n=22) and 86 minutes for Field (n=22). ED had the highest proportion of patients achieving goal DTD time (81%) compared to Transfers (42%). Patients arriving by ED during OFF hours had a median DTD time 28 minutes longer than during ON hours with 21% fewer patients achieving goal DTD time, attributed to the time required to call in the catheterization team. Seasonal variability was observed due to differences in pre-hospital ambulance transportation times in the Field group. Conclusions:Our data confirm that in a rural facility such as ours, ED patients arriving during afterhours and transferred patients have longer DTD times. Methods are being implemented to shorten the time to assemble the catheterization lab team during after-hours. Better performance will be seen once the first medical contact to device (FTD) time goal of 120 minutes for transferred patients is adopted at our institution. Fibrinolytic therapy should be considered at referring institutions where the FTD time is expected to exceed 120 minutes.

show abstract

“…Rather than simply voicing dissatisfaction with the current situation, clinicians must act to reduce the DTB time using our limited resources, without waiting for the implementation of measures by the central or local government. Indeed, individual hospitals have reported reductions in DTB time of 20-40 minutes in other countries (Niles et al 2010;Lin et al 2011;Young Hee et al 2011;Pan et al 2014).…”

Section: Introductionmentioning

confidence: 99%

Reduction in Door-to-Balloon Time with Training for Effective and Efficient Action in Medical Service-Better Process (TEAMS-BP) at a Community Hospital in Japan

Isono

Maeno

Watanabe

2018

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

ST-elevation myocardial infarction (STEMI) is a fatal condition. Prompt primary percutaneous coronary intervention is associated with lower mortality. However, community hospitals in Japan lack human and medical resources, and implementation of the same strategies as those used in the USA, such as an on-call cardiologist at the hospital, to achieve a door-to-balloon time of ≤ 90 min appears particularly challenging. Therefore, we used Training for Effective and Efficient Action in Medical Service-Better Process (TEAMS-BP) to develop a new process and assessed its effectiveness in reducing door-to-balloon time. TEAMS-BP can optimize the process by making the best use of available materials, machines, facilities and manpower. All processes conducted by physicians, nurses, electrocardiogram technicians, radiological technologists, and clerical staff in the emergency room were reviewed, documented, and standardized using the four steps of TEAMS-BP. The following processes were implemented: setting time goals, calling an electrocardiogram technician beforehand, minimizing tasks before calling a cardiologist, confirming the checklist, and providing data feedback. Forty-four STEMI patients who were treated after TEAMS-BP implementation were compared with 58 who were treated before implementation. Median door-to-balloon, door-to-electrocardiogram and door-to-laboratory times were significantly reduced after TEAMS-BP implementation, decreasing from 106 to 82 min, 14 to 6 min, and 67 to 45 min, respectively. In conclusion, implementation of TEAMS-BP improved the door-to-balloon time of STEMI cases without additional resources or costs incurred by the hospital. TEAMS-BP can be implemented by any hospital wishing to develop a new process that accommodates local working conditions.

show abstract

Primary Percutaneous Coronary Intervention for Patients Presenting With ST-Segment Elevation Myocardial Infarction: Process Improvement in a Rural ST-Segment Elevation Myocardial Infarction Receiving Center

Cited by 12 publications

References 25 publications

Current Trends for ST-segment Elevation Myocardial Infarction during the Past 5 Years in Rural Areas of China's Liaoning Province

Current Trends for ST-segment Elevation Myocardial Infarction during the Past 5 Years in Rural Areas of China's Liaoning Province

Variability of Door-to-Device Times at a Rural Tertiary Care Center

Reduction in Door-to-Balloon Time with Training for Effective and Efficient Action in Medical Service-Better Process (TEAMS-BP) at a Community Hospital in Japan

Contact Info

Product

Resources

About