Laurie J Lambert1, Kevin A Brown2, Lucy J Boothroyd2, Eli Segal2, Sébastien Maire2, Simon Kouz2, Dave Ross2, Richard Harvey2, Stéphane Rinfret2, Yongling Xiao2, James Nasmith2, Peter Bogaty2. 1. From the Cardiology Evaluation Unit, Institut national d'excellence en santé et en services sociaux (INESSS), Montreal, Quebec, Canada (L.J.L., K.A.B., L.J.B., Y.X., P.B.); Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada (E.S.); Corporation d'Urgences-santé, Montreal, Quebec, Canada (E.S., D.R.); Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis, Lévis, Quebec, Canada (S.M.); Centre hospitalier régional de Lanaudière, Joliette, Quebec, Canada (S.K.); Services préhospitaliers d'urgence en Montérégie, Longueuil, Quebec, Canada (D.R.); Département de médecine préhospitalière, Hôpital Sacré-Cœur de Montréal, Montreal, Quebec, Canada (D.R.); Université de Sherbrooke, Sherbrooke, Quebec, Canada (R.H.); Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec, Canada (S.R., P.B.); and St. Paul's Hospital, Vancouver, British Columbia, Canada (J.N.). laurie.lambert@inesss.qc.ca. 2. From the Cardiology Evaluation Unit, Institut national d'excellence en santé et en services sociaux (INESSS), Montreal, Quebec, Canada (L.J.L., K.A.B., L.J.B., Y.X., P.B.); Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada (E.S.); Corporation d'Urgences-santé, Montreal, Quebec, Canada (E.S., D.R.); Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis, Lévis, Quebec, Canada (S.M.); Centre hospitalier régional de Lanaudière, Joliette, Quebec, Canada (S.K.); Services préhospitaliers d'urgence en Montérégie, Longueuil, Quebec, Canada (D.R.); Département de médecine préhospitalière, Hôpital Sacré-Cœur de Montréal, Montreal, Quebec, Canada (D.R.); Université de Sherbrooke, Sherbrooke, Quebec, Canada (R.H.); Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec, Canada (S.R., P.B.); and St. Paul's Hospital, Vancouver, British Columbia, Canada (J.N.).
Abstract
BACKGROUND: Interhospital transfer of patients with ST-elevation myocardial infarction (STEMI) for primary percutaneous coronary intervention (PPCI) is associated with longer delays to reperfusion, related in part to turnaround ("door in" to "door out," or DIDO) time at the initial hospital. As part of a systematic, province-wide evaluation of STEMI care, we examined DIDO times and associations with patient, hospital, and process-of-care factors. METHODS AND RESULTS: We performed medical chart review for STEMI patients transferred for PPCI during a 6-month period (October 1, 2008, through March 31, 2009) and linked these data to ambulance service databases. Two core laboratory cardiologists reviewed presenting ECGs to identify left bundle-branch block and, in the absence of left bundle-branch block, definite STEMI (according to both cardiologists) or an ambiguous reading. Median DIDO time was 51 minutes (25th to 75th percentile: 35-82 minutes); 14.1% of the 988 patients had a timely DIDO interval (≤30 minutes as recommended by guidelines). The data-to-decision delay was the major contributor to DIDO time. Female sex, more comorbidities, longer symptom duration, arrival by means other than ambulance, arrival at a hospital not exclusively transferring for PPCI, arrival at a center with a low STEMI volume, and an ambiguous ECG were independently associated with longer DIDO time. When turnaround was timely, 70% of patients received timely PPCI (door-to-device time ≤90 minutes) versus 14% if turnaround was not timely (P<0.0001). CONCLUSIONS: Benchmark DIDO times for STEMI patients transferred for PPCI were rarely achieved. Interventions aimed at facilitating the transfer decision, particularly in cases of ECGs that are difficult to interpret, are likely to have the best impact on reducing delay to reperfusion.
BACKGROUND: Interhospital transfer of patients with ST-elevation myocardial infarction (STEMI) for primary percutaneous coronary intervention (PPCI) is associated with longer delays to reperfusion, related in part to turnaround ("door in" to "door out," or DIDO) time at the initial hospital. As part of a systematic, province-wide evaluation of STEMI care, we examined DIDO times and associations with patient, hospital, and process-of-care factors. METHODS AND RESULTS: We performed medical chart review for STEMI patients transferred for PPCI during a 6-month period (October 1, 2008, through March 31, 2009) and linked these data to ambulance service databases. Two core laboratory cardiologists reviewed presenting ECGs to identify left bundle-branch block and, in the absence of left bundle-branch block, definite STEMI (according to both cardiologists) or an ambiguous reading. Median DIDO time was 51 minutes (25th to 75th percentile: 35-82 minutes); 14.1% of the 988 patients had a timely DIDO interval (≤30 minutes as recommended by guidelines). The data-to-decision delay was the major contributor to DIDO time. Female sex, more comorbidities, longer symptom duration, arrival by means other than ambulance, arrival at a hospital not exclusively transferring for PPCI, arrival at a center with a low STEMI volume, and an ambiguous ECG were independently associated with longer DIDO time. When turnaround was timely, 70% of patients received timely PPCI (door-to-device time ≤90 minutes) versus 14% if turnaround was not timely (P<0.0001). CONCLUSIONS: Benchmark DIDO times for STEMI patients transferred for PPCI were rarely achieved. Interventions aimed at facilitating the transfer decision, particularly in cases of ECGs that are difficult to interpret, are likely to have the best impact on reducing delay to reperfusion.
Authors: Nichole Bosson; Terrence Baruch; William J French; Andrea Fang; Amy H Kaji; Marianne Gausche-Hill; Alisa Rock; David Shavelle; Joseph L Thomas; James T Niemann Journal: J Am Heart Assoc Date: 2017-12-23 Impact factor: 5.501
Authors: Oumin Shi; Anam M Khan; Mohammad R Rezai; Cynthia A Jackevicius; Jafna Cox; Clare L Atzema; Dennis T Ko; Thérèse A Stukel; Laurie J Lambert; Madhu K Natarajan; Zhi-Jie Zheng; Jack V Tu Journal: BMC Cardiovasc Disord Date: 2018-10-29 Impact factor: 2.298