PMID- 26734280
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20160106
LR  - 20201001
IS  - 2050-1315 (Print)
IS  - 2050-1315 (Electronic)
IS  - 2050-1315 (Linking)
VI  - 3
IP  - 1
DP  - 2014
TI  - Reducing time to reperfusion for ST elevation myocardial infarction patients by a 
      simple process change in the Emergency Department.
LID - 10.1136/bmjquality.u204753.w2063 [doi]
LID - u204753.w2063
AB  - Current reperfusion guidelines from the European Society of Cardiology (ESC) 
      recommend that First Medical Contact to Balloon times (FMC-B) for ST elevation 
      myocardial infarction (STEMI) should not exceed 120 minutes. Many factors can 
      cause delay in door to balloon times for patients suffering from STEMI. Previous 
      studies have found that longest times for FMC-B occur if the patient presents 
      initially to a non-percutaneous intervention (PCI) capable hospital. As a non-PCI 
      capable site we looked at ways of reducing FMC-B times. Audit revealed that 
      registration to electrocardiogram (ECG) times were sometimes prolonged due to 
      undertriage, long waiting times and lack of space and staff to record an ECG, 
      resulting in some prolonged FMC-B times. To address this, we have changed the 
      system so that patients bypass triage and go directly to a dedicated 
      investigation cubicle for an ECG. The patient books on at reception with chest 
      pain and is immediately directed to the investigation cubicle. The ECG is 
      reviewed immediately and the patient is either kept in the department for further 
      management or allowed back to the waiting room to await triage if the ECG is 
      non-diagnostic and history not worrying. Data on patients presenting with STEMI 
      on the initial ECG were collected for one year pre-intervention (n=21 )and one 
      year post-intervention (n=17). The median FMC-B time for the pre-intervention 
      group was 108.5 minutes (IQR 96 - 143.5). Median FMC-B time for the 
      post-intervention group was 82 minutes (IQR 66.5-93.5). This is a simple, 
      low-cost intervention which could be transferable to other sites who have an 
      interest in reducing FMC-B times. It is necessary to have a key person to carry 
      out audit of all potential areas of delay, and a collaborative, multidisciplinary 
      approach to making change to improve quality of care.
FAU - Byrne, Jill
AU  - Byrne J
AD  - Belfast Health and Social care Trust.
LA  - eng
PT  - Journal Article
DEP - 20140611
PL  - England
TA  - BMJ Qual Improv Rep
JT  - BMJ quality improvement reports
JID - 101629512
PMC - PMC4645850
EDAT- 2014/01/01 00:00
MHDA- 2014/01/01 00:01
PMCR- 2014/06/11
CRDT- 2016/01/07 06:00
PHST- 2014/04/23 00:00 [received]
PHST- 2014/05/03 00:00 [revised]
PHST- 2016/01/07 06:00 [entrez]
PHST- 2014/01/01 00:00 [pubmed]
PHST- 2014/01/01 00:01 [medline]
PHST- 2014/06/11 00:00 [pmc-release]
AID - bmjquality_uu204753.w2063 [pii]
AID - 10.1136/bmjquality.u204753.w2063 [doi]
PST - epublish
SO  - BMJ Qual Improv Rep. 2014 Jun 11;3(1):u204753.w2063. doi: 
      10.1136/bmjquality.u204753.w2063. eCollection 2014.