Impact of a well-organized collaborative team approach on mortality in patients with ST-segment elevation myocardial...

Fibrinolytic therapy remains a legitimate option for many patients presenting with acute ST-segment elevation myocardial infarction (STEMI). Shorter time- to- treatment for patients with STEMI administered fibrinolytic therapy has repeatedly been shown to reduce mortality. A well-organized collaborative team approach was implemented in April 2007. The purpose of this study was to examine the effect of implementing a well-organized collaborative team approach on the outcome in patients with acute STEMI treated with fibrinolysis.

Sociodemographic, clinical, laboratory, and time interval data were prospectively collected on 109 consecutive patients (the study group) and 155 patients from the years 2005-2007 (the control group) retrospectively. A single-phone call was made to discuss case. Emergency department evaluation was bypassed for definitive case. An electrocardiogram was faxed to the on-call cardiologist for suspected case. Door-to-needle times were calculated as medians. Mortality was assessed by reviewing records of all patients visiting outpatient clinic. For the rest, information was obtained over the phone. Median door-to-needle times were compared using Mann-Whitney U test. The Fisher's exact test was used to compare 6-month mortalities.

Improvements were seen in door-to- needle times in the study group regardless of time of presentation (reduced from 59 minutes to 29 minutes during off hours) (reduced from 35 minutes to 18 minutes during regular hours) (p<0.0001). Mortality was significantly reduced in the study group (2 deaths, 1.8%) compared with the control group (12 deaths, 7.7%, p=0.048).

The mortality of patients presenting with acute STEMI treated with fibrinolytic therapy was significantly reduced after optimal hospital organization.