Process factors affecting door to percutaneous coronary intervention for acute myocardial infarction patients
Michael A Horst1, Jennifer J Stuart, Nichole McKinsey
1Lancaster General Research Institute, Lancaster General Hospital, PA 17604, USA. mahorst@lghealth.org
Insights
Prompt reperfusion for acute myocardial infarction (AMI) patients is crucial. Key factors delaying door-to-balloon time include portable chest X-rays, mode of arrival, and emergency department visit timing.
Area of Science:
- Cardiology
- Healthcare Management
- Public Health
Background:
- Timely reperfusion therapy is critical for improving outcomes in patients with acute myocardial infarction (AMI).
- Door-to-balloon (D2B) time is a key metric for assessing the efficiency of AMI care pathways.
- Identifying factors that influence D2B time is essential for optimizing treatment protocols.
Purpose of the Study:
- To identify key predictor variables impacting door-to-balloon time in acute myocardial infarction (AMI) patients.
- To analyze arrival, process, and patient-related factors influencing reperfusion delays.
- To provide insights for improving the efficiency of AMI treatment in emergency departments.
Main Methods:
- Cross-sectional study utilizing retrospective data from 273 patients over two calendar years (2006-2007).
- Multivariate linear regression analysis to identify significant predictor variables for D2B time.
- Examination of variables including patient arrival mode, diagnostic procedures, and emergency department (ED) encounter characteristics.
Main Results:
- The average door-to-balloon time was 76.77 minutes (range: 28-167 minutes).
- Significant predictors of delayed D2B time included portable chest X-ray, presentation as walk-in versus ambulance, time of ED arrival (day vs. night), ED day of arrival (weekday vs. weekend), prior 'code R' activation, and reported chest pain on ED admission.
- Specific factors related to patient presentation and hospital processes were found to influence reperfusion timeliness.
Conclusions:
- Several key factors significantly impact door-to-balloon time for acute myocardial infarction patients.
- Optimizing emergency department workflows and patient triage processes can help reduce reperfusion delays.
- Addressing identified predictors may lead to improved and more rapid treatment for AMI patients, enhancing clinical outcomes.
Abstract:
The purpose of this cross-sectional study was to identify key predictor variables with the most impact on door-to-balloon time for acute myocardial infarction patients. The authors examined arrival, process, and patient-related variables from retrospective data from calendar years 2006 and 2007 within a single community hospital (N = 273). The door-to-balloon time ranged from 28 to 167 minutes, with an average of 76.77 (standard deviation ±24.5) minutes. Key predictor variables identified through multivariate linear regression included portable chest X-ray, presentation from walk-in versus ambulance, responding cardiology group, emergency department (ED) time of arrival (day 8 AM to 5 PM or night 5 PM to 8 AM), ED day of arrival (weekday or weekend), if a code R was called prior to arrival, and if the patient was identified as having chest pain on admission to the ED. For patients with acute myocardial infarction at a single study site, the authors identified a number of key factors that delay prompt reperfusion.
More Related Videos
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Cardiac Catheterization IV: Nursing Management
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:30Acute Coronary Syndrome I: Introduction
01:26Acute Coronary Syndrome V: Nursing Management
01:26Angina IV: Management