Article Instance

HTTP 200 OK
Allow: GET
Content-Type: application/json
Vary: Accept

{
    "pk": 8461,
    "title": "Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients",
    "subtitle": null,
    "abstract": "Introduction: \nThe American Heart Association/American College of Cardiology guidelines recommend rapid door-to-electrocardiography (ECG) times for patients with ST-segment elevation myocardial infarction (STEMI). Previous quality improvement research at our institution revealed that we were not meeting this benchmark for walk-in STEMI patients. The objective is to investigate whether simple, directed changes in the emergency department (ED) triage process for potential cardiac patients could decrease door-to-ECG times and secondarily door-to-balloon times.\nMethods: \nWe conducted an interventional study at a large, urban, public teaching hospital from April 2010 to June 2012. All patients who walked into the ED with a confirmed STEMI were enrolled in the study. The primary intervention involved creating a chief complaint-based “cardiac triage” designation that streamlined the evaluation of potential cardiac patients. A secondary intervention involved moving our ECG technician and ECG station to our initial triage area. The primary outcome measure was door-to-ECG time and the secondary outcome measure was door-to-balloon time.\nResults: \nWe enrolled 91 walk-in STEMI patients prior to the intervention period and 141 patients after the invention. We observed statistically significant reductions in door-to-ECG time (43±93 to 30±72 minutes, median 23 to 14 minutes p<0.01), ECG-to-activation time (87±134 to 52±82 minutes, median 43 to 31 minutes p<0.01), and door-to-balloon time (134±146 to 84±40 minutes, median 85 -75 minutes p=0.03).\nConclusion: \nBy creating a chief complaint-based cardiac triage protocol and by streamlining ECG completion, walk-in STEMI patients are systematically processed through the ED. This is not only associated with a decrease in door-to-balloon time, but also a decrease in the variability of the time sensitive intervals of door-to-ECG and ECG-to-balloon time. [West J Emerg Med. 2015;16(1):–0.]",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Cardiology, Emergency Medicine, Quality Improvement, Door-to-Balloon, Door-to-ECG, Triage"
        }
    ],
    "section": "Technology in Emergency Medicine",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/503452nd",
    "frozenauthors": [
        {
            "first_name": "Christopher",
            "middle_name": "J.",
            "last_name": "Coyne",
            "name_suffix": "",
            "institution": "Los Angeles County/ University of Southern California, Department of Emergency Medicine, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Nicholas",
            "middle_name": "",
            "last_name": "Testa",
            "name_suffix": "",
            "institution": "Los Angeles County/ University of Southern California, Department of Emergency Medicine, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Shoma",
            "middle_name": "",
            "last_name": "Desai",
            "name_suffix": "",
            "institution": "Los Angeles County/ University of Southern California, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Joy",
            "middle_name": "",
            "last_name": "Lagrone",
            "name_suffix": "",
            "institution": "Los Angeles County/ University of Southern California, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Roger",
            "middle_name": "",
            "last_name": "Chang",
            "name_suffix": "",
            "institution": "Los Angeles County/ University of Southern California, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Ling",
            "middle_name": "",
            "last_name": "Zheng",
            "name_suffix": "",
            "institution": "Los Angeles County/ University of Southern California, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Hyung",
            "middle_name": "",
            "last_name": "Kim",
            "name_suffix": "",
            "institution": "Los Angeles County/ University of Southern California, Los Angeles, California",
            "department": "None"
        }
    ],
    "date_submitted": "2014-07-24T01:25:47Z",
    "date_accepted": "2014-07-24T01:25:47Z",
    "date_published": "2014-12-09T20:18:27Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/8461/galley/4886/download/"
        }
    ]
}