Safe Triage of STEMI Patients to General Telemetry Units After Successful Primary Percutaneous Coronary Intervention
John Z Nan1, Jacob C Jentzer1, Robert C Ward1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Insights
A Zwolle score-based algorithm safely triages low-risk ST-segment elevation myocardial infarction (STEMI) patients post-percutaneous coronary intervention (PCI) to general telemetry units. This approach reduces hospital length of stay without compromising patient outcomes or safety.
Area of Science:
- Cardiology
- Clinical Quality Improvement
- Health Services Research
Background:
- ST-segment elevation myocardial infarction (STEMI) management involves complex post-percutaneous coronary intervention (PCI) care pathways.
- Optimizing resource allocation in cardiac intensive care units (CICUs) is crucial for efficient patient management.
- Risk stratification tools can guide appropriate patient disposition after acute cardiac events.
Purpose of the Study:
- To evaluate the safety and efficacy of triaging STEMI patients post-PCI to a general telemetry unit versus a CICU.
- To assess the impact of a Zwolle risk score-based algorithm on patient outcomes and resource utilization.
Main Methods:
- A quality improvement protocol was implemented, directing STEMI patients with a Zwolle score ≤3 to general telemetry units.
- A retrospective single-center cohort study analyzed data from 547 STEMI patients undergoing primary PCI between 2014 and 2018.
- Outcomes included immediate complications, unplanned interventions, CICU transfer, length of stay, and survival.
Main Results:
- Of 406 low-risk STEMI patients (Zwolle score ≤3), 192 were admitted to general telemetry and 214 to CICU.
- General telemetry patients had a significantly shorter average hospital stay (2.1 days vs. 3.3 days, P<.001).
- There were no significant differences in major adverse events, with only two transfers from telemetry to CICU and one non-cardiac in-hospital death.
Conclusions:
- A Zwolle score-based algorithm enables safe and effective triage of post-PCI STEMI patients to general telemetry units.
- This strategy can optimize CICU resources while maintaining high standards of care for low-risk STEMI patients.
Objective:
To analyze outcomes of patients with ST-segment elevation myocardial infarction (STEMI) after successful primary percutaneous coronary intervention (PCI) triaged to the cardiac intensive care unit (CICU) vs a general telemetry unit by a Zwolle risk score-based algorithm.
Methods:
We introduced a quality improvement protocol in 2014 encouraging admission of STEMI patients with Zwolle score of 3 or less to general telemetry units unless they were hemodynamically unstable. We subsequently conducted a retrospective single-center cohort study of consecutive STEMI patients who had undergone primary PCI from January 1, 2014, to December 31, 2018. Outcomes studied include immediate complications, need for urgent unplanned intervention, need for CICU care, length of hospitalization, and survival.
Results:
We identified 547 patients, 406 with a Zwolle score of 3 or less. Of these, 192 (47.3%) were admitted to general telemetry and 214 (52.7%) to the CICU. Reasons for CICU admission included persistent chest pain, late presentation, and procedural complications. The average hospital length of stay was 2.1±1.4 days for non-CICU patients and 3.3±2.8 days for low-risk CICU patients (P<.001). Two patients initially admitted to general telemetry required transfer to the CICU. There were 26 patients who required unplanned cardiovascular intervention within 30 days, 5 from the general telemetry unit; 540 patients survived to discharge. One in-hospital death occurred among those initially triaged to the general telemetry unit, and this was due to a noncardiac cause.
Conclusion:
A Zwolle score-based algorithm can be used to safely triage post-PCI STEMI patients to a general telemetry unit.
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