PMID- 28458558
OWN - NLM
STAT- MEDLINE
DCOM- 20170912
LR  - 20181113
IS  - 1178-2048 (Electronic)
IS  - 1176-6344 (Print)
IS  - 1176-6344 (Linking)
VI  - 13
DP  - 2017
TI  - Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon 
      time in an academic medical center.
PG  - 139-142
LID - 10.2147/VHRM.S132405 [doi]
AB  - OBJECTIVES: To assess if a change in our cardiology fellowship program impacted 
      our ST elevation myocardial infarction (STEMI) program. BACKGROUND: Fellows 
      covering the cardiac care unit were spending excessive hours in the hospital 
      while on call, resulting in increased duty hours violations. A night float fellow 
      system was started on July 1, 2012, allowing the cardiac care unit fellow to sign 
      out to a night float fellow at 5:30 pm. The night float fellow remained in-house 
      until the morning. METHODS: We performed a retrospective study assessing symptom 
      onset to arrival, arterial access to first device, and door-to-balloon (D2B) 
      times, in consecutive STEMI patients presenting to our emergency department 
      before and after initiation of the night float fellow system. RESULTS: From 2009 
      to 2013, 208 STEMI patients presented to our emergency department and underwent 
      primary percutaneous coronary intervention. There was no difference in symptom 
      onset to arrival (150+/-102 minutes vs 154+/-122 minutes, p=0.758), arterial access 
      to first device (12+/-8 minutes vs 11+/-7 minutes, p=0.230), or D2B times (50+/-32 
      minutes vs 52+/-34 minutes, p=0.681) during regular working hours. However, there 
      was a significant decrease in D2B times seen during off-hours (72+/-33 minutes vs 
      49+/-15 minutes, p=0.007). There was no difference in in-hospital mortality (11% vs 
      8%, p=0.484) or need for intra-aortic balloon pump placement (7% vs 8%, p=0.793). 
      CONCLUSION: In academic medical centers, in-house cardiology fellow coverage 
      during off-hours may expedite care of STEMI patients.
FAU - Kohan, Luke C
AU  - Kohan LC
AD  - Division of Cardiology.
FAU - Nagarajan, Vijaiganesh
AU  - Nagarajan V
AD  - Division of Cardiology.
FAU - Millard, Michael A
AU  - Millard MA
AD  - Department of Medicine, University of Virginia, Charlottesville, VA, USA.
FAU - Loguidice, Michael J
AU  - Loguidice MJ
AD  - Department of Medicine, University of Virginia, Charlottesville, VA, USA.
FAU - Fauber, Nancy M
AU  - Fauber NM
AD  - Division of Cardiology.
FAU - Keeley, Ellen C
AU  - Keeley EC
AD  - Division of Cardiology.
LA  - eng
PT  - Journal Article
DEP - 20170418
PL  - New Zealand
TA  - Vasc Health Risk Manag
JT  - Vascular health and risk management
JID - 101273479
SB  - IM
MH  - *Academic Medical Centers
MH  - After-Hours Care/*organization & administration
MH  - Aged
MH  - Angioplasty, Balloon, Coronary/adverse effects/mortality
MH  - Cardiologists/*organization & administration
MH  - Cardiology Service, Hospital/organization & administration
MH  - Delivery of Health Care, Integrated/*organization & administration
MH  - Efficiency, Organizational
MH  - Emergency Service, Hospital/organization & administration
MH  - Female
MH  - Health Services Research
MH  - Humans
MH  - Internship and Residency/*organization & administration
MH  - Male
MH  - Middle Aged
MH  - Models, Organizational
MH  - Personnel Staffing and Scheduling/*organization & administration
MH  - Retrospective Studies
MH  - ST Elevation Myocardial Infarction/diagnosis/mortality/*therapy
MH  - Time Factors
MH  - Time-to-Treatment/*organization & administration
MH  - Treatment Outcome
MH  - Workflow
MH  - Workload
PMC - PMC5403126
OTO - NOTNLM
OT  - 24/7 in-house call
OT  - cardiology fellow
OT  - door-to-balloon time
COIS- Disclosure The authors report no conflicts of interest in this work.
EDAT- 2017/05/02 06:00
MHDA- 2017/09/13 06:00
PMCR- 2017/04/18
CRDT- 2017/05/02 06:00
PHST- 2017/05/02 06:00 [entrez]
PHST- 2017/05/02 06:00 [pubmed]
PHST- 2017/09/13 06:00 [medline]
PHST- 2017/04/18 00:00 [pmc-release]
AID - vhrm-13-139 [pii]
AID - 10.2147/VHRM.S132405 [doi]
PST - epublish
SO  - Vasc Health Risk Manag. 2017 Apr 18;13:139-142. doi: 10.2147/VHRM.S132405. 
      eCollection 2017.