[ST-elevation Myocardial Infarction and Percutaneous Coronary Intervention: Analysis of Time Stamps in Hospital...

German hospital administrative data contain demographic, medical, and administrative information on inpatients, as well as time stamps, such as time of admission or when a medical procedure was carried out. Time stamps allow the calculation of important process indicators which may help to assess quality of care. However, regarding the plausibility of time stamps in German hospital administrative data, no information is as yet available. This study investigates time stamps through the example of ST-elevation myocardial infarction and percutaneous coronary intervention aiming to provide first indications on the plausibility of time stamp documentation.

Based on complete national German hospital administrative data (DRG statistics) from 2014 to 2017, all inpatient cases with ST-elevation myocardial infarction in the first admitting hospital were identified. Date and time of admission and date and time of percutaneous coronary intervention were analyzed. Time intervals were calculated as difference between time of admission and time of percutaneous coronary intervention and were categorized in groups.

The analysis of time of admission of inpatient cases with ST-elevation myocardial infarction (n=254,719) showed a pattern with highest frequencies between 9 a.m. and 1 p.m. on working days. The pattern of time of percutaneous coronary interventions (n=206,079) was similar but revealed frequency peaks at noon and midnight. The share of inpatient cases with implausible time intervals between time of admission and time of percutaneous coronary intervention declined from 9.5% in 2014 to 7.8% in 2017 and showed high variation on the hospital level.

Analyzing time stamps in hospital administrative data may provide valuable information on treatment processes while clinical staff may be released from separate documentation tasks. However, the results of this study indicate that the reliability of time stamps is affected by implausible entries and several uncertainties. The quality of time stamp documentation in German hospital administrative data might be improved by setting incentives for correct documentation and by setting out definite specifications of time points, such as time of admission.