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Round-off decision-making: Why do triage nurses assign STEMI patients with an average priority?

Mor Saban1, Lev Zaretsky1, Heli Patito1

  • 1The Cheryl Spencer Department of Nursing, University of Haifa, Israel; Rambam Health Care Campus, Haifa, Israel.

International Emergency Nursing
|July 29, 2018
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Summary

Patients with ST elevation myocardial infarction (STEMI) often receive lower triage priority, increasing risks. Female patients and those of Arab ethnicity were more likely to be misclassified, impacting outcomes.

Keywords:
Chest PainDoor-To-Balloon TimeEmergency departmentST elevation myocardial infarctionTriage

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Area of Science:

  • Emergency Medicine
  • Cardiology
  • Health Services Research

Background:

  • ST elevation myocardial infarction (STEMI) requires high-priority emergency department (ED) triage to minimize mortality and morbidity.
  • A significant proportion of STEMI patients are assigned a lower triage priority (P3), indicating a potential flaw in the current system.
  • This under-triage of STEMI patients can lead to delayed treatment and adverse health outcomes.

Purpose of the Study:

  • To identify specific factors contributing to the misclassification of ST elevation myocardial infarction patients with an average triage priority (P3).
  • To clarify the impact of sociodemographic and clinical characteristics on STEMI triage decisions.
  • To understand the association between P3 classification and adverse treatment outcomes in STEMI patients.

Main Methods:

  • A retrospective study analyzed data from 140 patients diagnosed with ST elevation myocardial infarction between January 2015 and November 2017 at a tertiary hospital.
  • Data collected included patient characteristics, ED setting variables, and hospitalization details, extracted from electronic health records.
  • Statistical analysis, including odds ratios (OR), was used to identify significant factors associated with P3 triage assignment.

Main Results:

  • Female gender (OR=1.96, P=.05) and Arab ethnicity (OR=2.19, P=.01) were significantly associated with P3 triage assignment.
  • The number of prior cardiac events was the only significant cardiologic comorbidity linked to P3 classification (P=.02).
  • Patients assigned P3 experienced poorer outcomes, including longer time to physician, longer total ED time, and longer door-to-balloon times, with increased in-hospital mortality.

Conclusions:

  • The assignment of average triage priority (P3) to STEMI patients is associated with significant risks and adverse outcomes.
  • Sociodemographic factors, specifically female gender and Arab ethnicity, play a role in STEMI under-triage.
  • This study highlights critical areas for improving STEMI triage protocols to ensure timely and appropriate care.