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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Effectiveness of a multidisciplinary critical pathway based on a computerised physician order entry system for
Yoo Seok Park1, Sung Phil Chung1, Je Sung You1
1Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Insights
A critical pathway (CP) for ST-segment elevation myocardial infarction (STEMI) management effectively reduced treatment time disparities, regardless of emergency department arrival. This approach minimized off-hour and weekend effects on STEMI care.
Area of Science:
- Cardiology
- Healthcare Management
- Clinical Pathways
Background:
- ST-segment elevation myocardial infarction (STEMI) requires rapid treatment.
- Off-hour and weekend delays in emergency department (ED) care can negatively impact STEMI outcomes.
- Standardized critical pathways (CPs) aim to improve patient care consistency.
Purpose of the Study:
- To evaluate if a multidisciplinary CP for STEMI management can reduce treatment time variations.
- To determine if the CP eliminates disparities related to emergency department arrival time (off-hours and weekends).
Main Methods:
- Retrospective observational cohort study at two tertiary academic hospitals.
- Analysis of consecutive patients within the Fast Interrogation Rule for STEMI (FIRST) program.
- Utilized a computerised physician order entry (CPOE) system to track demographics, time intervals, and clinical outcomes based on ED arrival time (weekday/off-hour, weekend/off-hour).
Main Results:
- No significant differences in door-to-data or FIRST activation times were observed across the four arrival groups.
- Door-to-balloon times within 90 minutes were achieved in 89.6-95.1% of patients, with no significant variation based on arrival time (p=0.147).
- No significant differences in 30-day or in-hospital mortality were found among the groups.
Conclusions:
- A multidisciplinary CP for STEMI, integrated with a CPOE system, effectively reduces disparities in door-to-data and door-to-balloon times.
- This standardized approach minimizes the impact of ED arrival time on STEMI treatment efficiency.
- The CP shows potential in attenuating off-hour and weekend effects on clinical outcomes for STEMI patients.
Objectives:
The purpose of this study was to investigate whether a multidisciplinary organised critical pathway (CP) for ST-segment elevation myocardial infarction (STEMI) management can significantly attenuate differences in the duration from emergency department (ED) arrival to evaluation and treatment, regardless of the arrival time, by eliminating off-hour and weekend effects.
Design:
Retrospective observational cohort study.
Setting:
2 tertiary academic hospitals.
Participants:
Consecutive patients in the Fast Interrogation Rule for STEMI (FIRST) program.
Interventions:
A study was conducted on patients in the FIRST program, which uses a computerised physician order entry (CPOE) system. The patient demographics, time intervals and clinical outcomes were analysed based on the arrival time at the ED: group 1, normal working hours on weekdays; group 2, off-hours on weekdays; group 3, normal working hours on weekends; and group 4, off-hours on weekends.
Primary And Secondary Outcome Measures:
Clinical outcomes categorised according to 30-day mortality, in-hospital mortality and the length of stay.
Results:
The duration from door-to-data or FIRST activation did not differ significantly among the 4 groups. The median duration between arrival and balloon placement during percutaneous coronary intervention did not significantly exceed 90 min, and the proportions (89.6-95.1%) of patients with door-to-balloon times within 90 min did not significantly differ among the 4 groups, regardless of the ED arrival time (p=0.147). Moreover, no differences in the 30-day (p=0.8173) and in-hospital mortality (p=0.9107) were observed in patients with STEMI.
Conclusions:
A multidisciplinary CP for STEMI based on a CPOE system can effectively decrease disparities in the door-to-data duration and proportions of patients with door-to-balloon times within 90 min, regardless of the ED arrival time. The application of a multidisciplinary CP may also help attenuate off-hour and weekend effects in STEMI clinical outcomes.
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