Effects of emergency department boarding on mortality in patients with ST-segment elevation myocardial infarction

Area of Science:

• Cardiology
• Critical Care Medicine
• Health Services Research

Background:

• Patients with ST-segment elevation myocardial infarction (STEMI) may experience delays in CCU admission due to emergency department (ED) boarding after percutaneous coronary intervention (PCI).
• Understanding the implications of ED boarding on patient outcomes and resource utilization is crucial for optimizing care pathways.

Purpose of the Study:

• To evaluate the impact of direct versus indirect CCU admission on mortality in STEMI patients post-PCI.
• To assess the effect of these admission strategies on length of stay (LOS) in the CCU and hospital.

Main Methods:

• A retrospective observational study analyzed 780 STEMI patients from January 2014 to November 2017.
• Patients were categorized into direct admission (DA) and indirect admission (IA) groups based on immediate CCU transfer versus ED boarding post-PCI.
• Primary endpoint was in-hospital mortality; secondary endpoints included 3-month mortality, CCU LOS, hospital LOS, and intensive care LOS.

Main Results:

• In-hospital and 3-month mortality rates were similar between the DA and IA groups (P=.50 and P=.28, respectively).
• Median CCU and hospital LOS did not differ significantly between the groups (P=.28 and P=.46, respectively).
• The indirect admission group experienced a significantly longer LOS under intensive care (38.7 hours) compared to the direct admission group (31.9 hours; P<.001).

Conclusions:

• Direct and indirect CCU admission strategies following PCI for STEMI are not associated with differences in patient mortality.
• ED boarding, a component of indirect admission, appears to correlate with an increased duration of intensive care.
• Optimizing patient flow from ED to CCU may reduce overall intensive care resource utilization.