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

Background: This study aimed at investigating the efficacy of utilizing a modified cardiac triage strategy at the emergency department for timely detection of ST-elevation myocardial infarction (STEMI). Methods: A chief complaint-based “cardiac triage” protocol comprising (1) raising alert among medical staff with bedside triage tags, and (2) immediate bedside electrocardiography (ECG) after focused history-taking was implemented at the emergency department of a single tertiary referral center since December 2018. All patients diagnosed with STEMI visiting the emergency department (ED) between November 2017 and January 2020 were retrospectively reviewed to investigate the effectiveness of the strategy by comparing the primary [i.e., door-to-ECG (DTE) time and achievement rate of DTE time<10 minutes] and secondary [i.e., door-to-balloon (DTB) time and achievement rate of DTB time<90 minutes] outcomes among STEMI patients before (pre-intervention) and after (post-intervention) strategy implementation. Results: Analysis of a total of 117 ED patients with STEMI (pre-intervention group, n=57; post-intervention group, n=60) showed significant overall improvements in median DTE time from 5 to 4 minutes ( p =0.02), achievement rate of DTE time<10 minutes from 45% to 57% ( p =0.01), median DTB time from 81 to 70 minutes ( p <0.01). Significant trends were also noted in achievement rates for DTE and DTB times ( p =0.01 and p =0.006, respectively) after strategy implementation. The incidence of DTE time>10 minutes for those with initially underestimated disease severity was also reduced from 90% to 10% ( p <0.01). Conclusions: A chief complaint-based “cardiac triage” strategy successfully improved the quality of emergency care for STEMI patients through reducing delays in diagnosis and treatment.