What is the clinical evidence from this study?

Study design: Other. Population: ST-segment elevation myocardial infarction (STEMI) (n=232). Intervention: Chief complaint-based cardiac triage protocol and ECG relocation vs. Standard triage protocol. Primary outcome: Door-to-ECG time (mean minutes) (p=<0.01).

January 1, 2015Western Journal of Emergency MedicineOpen Access

Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients

Q: What are the key findings of this study?

A chief complaint-based cardiac triage protocol and streamlined ECG completion significantly reduced median door-to-ECG time from 23 to 14 minutes (p<0.01) in walk-in STEMI patients.

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Key result

A chief complaint-based cardiac triage protocol and streamlined ECG completion significantly reduced median door-to-ECG time from 23 to 14 minutes (p<0.01) in walk-in STEMI patients.

Why the study?

Does a chief complaint-based cardiac triage protocol reduce door-to-ECG and door-to-balloon times in walk-in STEMI patients?

Population

232 walk-in emergency department patients with confirmed STEMI at a large, urban, public teaching hospital.

Comparison

Chief complaint-based 'cardiac triage'… vs Standard triage process prior to the…

Design

Cohort

Authors

CCChristopher John Coyne NTNicholas Testa SDShoma Desai

Discussion

Member takes

Overview

Triage changes were associated with shorter door-to-ECG and door-to-balloon times; supports targeted ED optimization but leaves open need for randomized confirmation.

Structured PICO

Does a chief complaint-based cardiac triage protocol reduce door-to-ECG and door-to-balloon times in walk-in STEMI patients?

Population

232 walk-in patients with confirmed STEMI evaluated before and after the implementation of a chief complaint-based cardiac triage protocol at a large urban teaching hospital.

Intervention

Chief complaint-based 'cardiac triage' designation and moving the ECG technician and ECG station to the initial triage area.

Comparator

Standard triage process prior to the intervention period.

Outcome

Door-to-ECG timesurrogate

Main Result

Absolute Event Rate: 30.3% vs 43.1%

p-value: p=<0.01

Implementing a chief complaint-based cardiac triage protocol and relocating ECG resources to the initial triage area significantly reduces door-to-ECG and door-to-balloon times for walk-in STEMI patients.

Limitations

Variables were changed simultaneously, making it impossible to isolate the effect of the triage designation versus the movement of the ECG technician.
Single-center study design may lack external validity.
Despite improvements, the study did not meet the recommended AHA/ACC guideline benchmark of 10 minutes for door-to-ECG time.
Potential confounding from staff knowledge of interval measurements being tracked.

Cite This Study

Coyne et al. (2015) studied ST-segment elevation myocardial infarction (STEMI) (n=232). Chief complaint-based cardiac triage protocol and ECG relocation vs. Standard triage protocol was evaluated on Door-to-ECG time (mean minutes) (p=<0.01). A chief complaint-based cardiac triage protocol and streamlined ECG completion significantly reduced median door-to-ECG time from 23 to 14 minutes (p<0.01) in walk-in STEMI patients.

synapsesocial.com/papers/6ab8a1bece4df7170c3ddcb0 https://doi.org/10.5811/westjem.2014.10.23277

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January 1, 2015Western Journal of Emergency MedicineOpen Access

Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients

View Full Paper

Ask AI

Bookmark

Key result

A chief complaint-based cardiac triage protocol and streamlined ECG completion significantly reduced median door-to-ECG time from 23 to 14 minutes (p<0.01) in walk-in STEMI patients.

Why the study?

Does a chief complaint-based cardiac triage protocol reduce door-to-ECG and door-to-balloon times in walk-in STEMI patients?

Population

232 walk-in emergency department patients with confirmed STEMI at a large, urban, public teaching hospital.

Comparison

Chief complaint-based 'cardiac triage'… vs Standard triage process prior to the…

Design

Cohort

Authors

CCChristopher John Coyne NTNicholas Testa SDShoma Desai

Discussion

Member takes

Overview

Triage changes were associated with shorter door-to-ECG and door-to-balloon times; supports targeted ED optimization but leaves open need for randomized confirmation.

Structured PICO

Does a chief complaint-based cardiac triage protocol reduce door-to-ECG and door-to-balloon times in walk-in STEMI patients?

Population

232 walk-in patients with confirmed STEMI evaluated before and after the implementation of a chief complaint-based cardiac triage protocol at a large urban teaching hospital.

Intervention

Chief complaint-based 'cardiac triage' designation and moving the ECG technician and ECG station to the initial triage area.

Comparator

Standard triage process prior to the intervention period.

Outcome

Door-to-ECG timesurrogate

Main Result

Absolute Event Rate: 30.3% vs 43.1%

p-value: p=<0.01

Limitations

Variables were changed simultaneously, making it impossible to isolate the effect of the triage designation versus the movement of the ECG technician.
Single-center study design may lack external validity.
Despite improvements, the study did not meet the recommended AHA/ACC guideline benchmark of 10 minutes for door-to-ECG time.
Potential confounding from staff knowledge of interval measurements being tracked.

Cite This Study

synapsesocial.com/papers/6ab8a1bece4df7170c3ddcb0 https://doi.org/10.5811/westjem.2014.10.23277

Also Consider

Synapse has enriched 3 closely related papers on similar clinical questions. Consider them for comparative context:

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