Care processes associated with quicker door-in-door-out times for patients with st-elevation-myocardial infarction requiring transfer results from a statewide regionalization program

Seth W. Glickman, Barbara L. Lytle, Fang-Shu Ou, Greg Mears, Sean O'Brien, Charles B. Cairns, J. Lee Garvey, David J. Bohle, Eric D. Peterson, James G. Jollis, Christopher B. Granger

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background-The ability to rapidly identify patients with ST-segment elevation-myocardial infarction (STEMI) at hospitals without percutaneous coronary intervention (PCI) and transfer them to hospitals with PCI capability is critical to STEMI regionalization efforts. Our objective was to assess the association of prehospital, emergency department (ED), and hospital processes of care implemented as part of a statewide STEMI regionalization program with door-in- door-out times at non-PCI hospitals. Methods and Results-Door-in-door- out times for 436 STEMI patients at 55 non-PCI hospitals were determined before (July 2005 to September 2005) and after (January 2007 to March 2007) a year-long implementation of standardized protocols as part of a statewide regionalization program (Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments, RACE). The association of 8 system care processes (encompassing emergency medical services [EMS], ED, and hospital settings) with door-in-door-out times was determined using multivariable linear regression. Median door-in- door-out times improved significantly with the intervention (before: 97.0 minutes, interquartile range, 56.0 to 160.0 minutes; after: 58.0 minutes, interquartile range, 35.0 to 90.0 minutes; P<0.0001). Hospital, ED, and EMS care processes were each independently associated with shorter door-in-door-out times (-17.7 [95% confidence interval,-27.5 to-7.9];-10.1 [95% confidence interval,-19.0 to-1.1], and-7.3 [95% confidence interval,-13.0 to-1.5] minutes for each additional hospital, ED, and EMS process, respectively). Combined, adoption of EMS processes was associated with the shortest median treatment times (44 versus 138 minutes for hospitals that adopted all EMS processes versus none). Conclusions-Prehospital, ED, and hospital processes of care were independently associated with shorter door-in- doorout times for STEMI patients requiring transfer. Adoption of several EMS processes was associated with the largest reduction in treatment times. These findings highlight the need for an integrated, system-based approach to improving STEMI care.

Original languageEnglish (US)
Pages (from-to)382-388
Number of pages7
JournalCirculation: Cardiovascular Quality and Outcomes
Volume4
Issue number4
DOIs
StatePublished - Jul 1 2011
Externally publishedYes

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Emergency Medical Services
Myocardial Infarction
Hospital Emergency Service
Hospital Departments
Confidence Intervals
Percutaneous Coronary Intervention
Patient Transfer
Reperfusion
Linear Models
Therapeutics

Keywords

  • Emergency medical services
  • Outcomes
  • STEMI care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Care processes associated with quicker door-in-door-out times for patients with st-elevation-myocardial infarction requiring transfer results from a statewide regionalization program. / Glickman, Seth W.; Lytle, Barbara L.; Ou, Fang-Shu; Mears, Greg; O'Brien, Sean; Cairns, Charles B.; Garvey, J. Lee; Bohle, David J.; Peterson, Eric D.; Jollis, James G.; Granger, Christopher B.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 4, No. 4, 01.07.2011, p. 382-388.

Research output: Contribution to journalArticle

Glickman, Seth W. ; Lytle, Barbara L. ; Ou, Fang-Shu ; Mears, Greg ; O'Brien, Sean ; Cairns, Charles B. ; Garvey, J. Lee ; Bohle, David J. ; Peterson, Eric D. ; Jollis, James G. ; Granger, Christopher B. / Care processes associated with quicker door-in-door-out times for patients with st-elevation-myocardial infarction requiring transfer results from a statewide regionalization program. In: Circulation: Cardiovascular Quality and Outcomes. 2011 ; Vol. 4, No. 4. pp. 382-388.
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abstract = "Background-The ability to rapidly identify patients with ST-segment elevation-myocardial infarction (STEMI) at hospitals without percutaneous coronary intervention (PCI) and transfer them to hospitals with PCI capability is critical to STEMI regionalization efforts. Our objective was to assess the association of prehospital, emergency department (ED), and hospital processes of care implemented as part of a statewide STEMI regionalization program with door-in- door-out times at non-PCI hospitals. Methods and Results-Door-in-door- out times for 436 STEMI patients at 55 non-PCI hospitals were determined before (July 2005 to September 2005) and after (January 2007 to March 2007) a year-long implementation of standardized protocols as part of a statewide regionalization program (Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments, RACE). The association of 8 system care processes (encompassing emergency medical services [EMS], ED, and hospital settings) with door-in-door-out times was determined using multivariable linear regression. Median door-in- door-out times improved significantly with the intervention (before: 97.0 minutes, interquartile range, 56.0 to 160.0 minutes; after: 58.0 minutes, interquartile range, 35.0 to 90.0 minutes; P<0.0001). Hospital, ED, and EMS care processes were each independently associated with shorter door-in-door-out times (-17.7 [95{\%} confidence interval,-27.5 to-7.9];-10.1 [95{\%} confidence interval,-19.0 to-1.1], and-7.3 [95{\%} confidence interval,-13.0 to-1.5] minutes for each additional hospital, ED, and EMS process, respectively). Combined, adoption of EMS processes was associated with the shortest median treatment times (44 versus 138 minutes for hospitals that adopted all EMS processes versus none). Conclusions-Prehospital, ED, and hospital processes of care were independently associated with shorter door-in- doorout times for STEMI patients requiring transfer. Adoption of several EMS processes was associated with the largest reduction in treatment times. These findings highlight the need for an integrated, system-based approach to improving STEMI care.",
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AU - Lytle, Barbara L.

AU - Ou, Fang-Shu

AU - Mears, Greg

AU - O'Brien, Sean

AU - Cairns, Charles B.

AU - Garvey, J. Lee

AU - Bohle, David J.

AU - Peterson, Eric D.

AU - Jollis, James G.

AU - Granger, Christopher B.

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N2 - Background-The ability to rapidly identify patients with ST-segment elevation-myocardial infarction (STEMI) at hospitals without percutaneous coronary intervention (PCI) and transfer them to hospitals with PCI capability is critical to STEMI regionalization efforts. Our objective was to assess the association of prehospital, emergency department (ED), and hospital processes of care implemented as part of a statewide STEMI regionalization program with door-in- door-out times at non-PCI hospitals. Methods and Results-Door-in-door- out times for 436 STEMI patients at 55 non-PCI hospitals were determined before (July 2005 to September 2005) and after (January 2007 to March 2007) a year-long implementation of standardized protocols as part of a statewide regionalization program (Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments, RACE). The association of 8 system care processes (encompassing emergency medical services [EMS], ED, and hospital settings) with door-in-door-out times was determined using multivariable linear regression. Median door-in- door-out times improved significantly with the intervention (before: 97.0 minutes, interquartile range, 56.0 to 160.0 minutes; after: 58.0 minutes, interquartile range, 35.0 to 90.0 minutes; P<0.0001). Hospital, ED, and EMS care processes were each independently associated with shorter door-in-door-out times (-17.7 [95% confidence interval,-27.5 to-7.9];-10.1 [95% confidence interval,-19.0 to-1.1], and-7.3 [95% confidence interval,-13.0 to-1.5] minutes for each additional hospital, ED, and EMS process, respectively). Combined, adoption of EMS processes was associated with the shortest median treatment times (44 versus 138 minutes for hospitals that adopted all EMS processes versus none). Conclusions-Prehospital, ED, and hospital processes of care were independently associated with shorter door-in- doorout times for STEMI patients requiring transfer. Adoption of several EMS processes was associated with the largest reduction in treatment times. These findings highlight the need for an integrated, system-based approach to improving STEMI care.

AB - Background-The ability to rapidly identify patients with ST-segment elevation-myocardial infarction (STEMI) at hospitals without percutaneous coronary intervention (PCI) and transfer them to hospitals with PCI capability is critical to STEMI regionalization efforts. Our objective was to assess the association of prehospital, emergency department (ED), and hospital processes of care implemented as part of a statewide STEMI regionalization program with door-in- door-out times at non-PCI hospitals. Methods and Results-Door-in-door- out times for 436 STEMI patients at 55 non-PCI hospitals were determined before (July 2005 to September 2005) and after (January 2007 to March 2007) a year-long implementation of standardized protocols as part of a statewide regionalization program (Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments, RACE). The association of 8 system care processes (encompassing emergency medical services [EMS], ED, and hospital settings) with door-in-door-out times was determined using multivariable linear regression. Median door-in- door-out times improved significantly with the intervention (before: 97.0 minutes, interquartile range, 56.0 to 160.0 minutes; after: 58.0 minutes, interquartile range, 35.0 to 90.0 minutes; P<0.0001). Hospital, ED, and EMS care processes were each independently associated with shorter door-in-door-out times (-17.7 [95% confidence interval,-27.5 to-7.9];-10.1 [95% confidence interval,-19.0 to-1.1], and-7.3 [95% confidence interval,-13.0 to-1.5] minutes for each additional hospital, ED, and EMS process, respectively). Combined, adoption of EMS processes was associated with the shortest median treatment times (44 versus 138 minutes for hospitals that adopted all EMS processes versus none). Conclusions-Prehospital, ED, and hospital processes of care were independently associated with shorter door-in- doorout times for STEMI patients requiring transfer. Adoption of several EMS processes was associated with the largest reduction in treatment times. These findings highlight the need for an integrated, system-based approach to improving STEMI care.

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