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November 13, 2020Open Access

A Modified Chief Complaint-Based Cardiac Triage Strategy for Reducing Delays in the Management of Patients With ST-Elevation Myocardial Infarction

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Why the study?

The study aimed to investigate the efficacy of a modified cardiac triage strategy at the emergency department for timely detection of STEMI.

Does a modified chief complaint-based cardiac triage strategy reduce door-to-ECG and door-to-balloon times in patients with STEMI?

Population

117 ED patients diagnosed with STEMI at a single tertiary referral center

Comparison

Post-intervention chief complaint-based cardiac triage protocol vs pre-intervention care

Design

Single-center retrospective before-and-after study

Authors

HSHung-Yuan SuJTJen-Long TsaiYHYin-Chou Hsu

Discussion

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Overview

Associated with shorter STEMI intervals; hypothesis-generating for randomized outcome trials.

Structured PICO

Does a modified chief complaint-based cardiac triage strategy reduce door-to-ECG and door-to-balloon times in patients with STEMI?

P
Population
117 adult patients (≥18 years old) diagnosed with ST-elevation myocardial infarction (STEMI) in the emergency department who subsequently received primary PCI, mean age ~62, ~87% male, at a single tertiary referral center in Taiwan.
I
Intervention
Modified chief complaint-based 'cardiac triage' protocol comprising early identification of possible ischemic cardiac symptoms by a triage nurse, labeling with a red bedside warning tag, and immediate bedside 12-lead ECG ordered by an emergency physician after focused history-taking.
C
Comparator
Standard pre-intervention management using a five-category triage system (Taiwan Triage and Acuity Scale) without specific cardiac triage tags or prioritized ECG acquisition.
O
Outcome
Median door-to-ECG (DTE) time and achievement rate of DTE time < 10 minutes.

A chief complaint-based cardiac triage strategy using bedside warning tags and focused history-taking significantly reduces door-to-ECG and door-to-balloon times for STEMI patients without requiring indiscriminate triage ECGs.

Limitations

  • Single center nature with a relatively small number of patients
  • Feasibility and effectiveness in other ED settings remains to be validated
  • Accuracy of data acquisition may be hampered by ambiguous symptom descriptions in medical records

Cite This Study

Su et al. (2020) studied this question.

synapsesocial.com/papers/6a1e4eaea42c1ff064327659https://doi.org/10.21203/rs.3.rs-104377/v1
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients2015 · 53 citations
  2. 2A Method for Improving Arrival‐to‐electrocardiogram Time in Emergency Department Chest Pain Patients and the Effect on Door‐to‐balloon Time for ST‐segment Elevation Myocardial Infarction2009 · 49 citations
  3. 3Quality improvement in the door‐to‐balloon times for ST‐elevation myocardial infarction patients presenting without chest pain2011 · 17 citations
  4. 4Improving Emergency Department Door-to-Electrocardiogram Time in ST Segment Elevation Myocardial Infarction2009 · 28 citations
  5. 5Reperfusion times for ST elevation myocardial infarction: a prospective audit2020 · 15 citations