Factors Influencing Time-Dependent Quality Indicators for Patients With Suspected Acute Coronary Syndrome.
Factors Influencing Time-Dependent Quality Indicators for Patients With Suspected Acute Coronary Syndrome.
复制标题
影响疑似急性冠状动脉综合征患者的时间依赖性质量指标的因素。
DOI：
10.1097/pts.0000000000000242
复制
发表时间：
2020-03
影响因子：
2.2
通讯作者：
Weinger M
中科院分区：
文献类型：
--
作者：
France DJ;Levin S;Ding R;Hemphill R;Han J;Russ S;Aronsky D;Weinger M
快速的危险分层和及时的治疗是急性冠脉综合征（ACS）患者获得良好结局的关键。我们的目的是确定影响急诊科（艾德）不稳定型心绞痛（UA）/非ST段抬高型心肌梗死（NSTEMI）患者时间依赖性质量指标（QIs）的患者和系统因素。对所有年龄在24岁或以上的疑似ACS患者（通过接受心电图（ECG）和至少一项心脏生物标志物检测定义）进行了为期42个月的回顾性队列研究。采用考克斯回归模型对患者特征、辅助服务利用率、人员配备、设备可用性和艾德以及医院拥挤对ACS QIs的影响进行建模。艾德对ECG读出时间和生物标志物周转时间的国家标准的遵守率分别为42%和37%。考克斯回归模型显示，无胸痛的主诉和压力测试和药物给药的时间与最显著的延迟相关。在UA/NSTEMI队列中，患者和系统因素均显著影响QI时间。这些结果说明了诊断NSTEMI患者的复杂性以及临床和系统因素对通过ED的患者流量的竞争影响。
Rapid risk stratification and timely treatment are critical to favorable outcomes for acute coronary syndrome (ACS) patients. Our objective was to identify patient and system factors that influence time-dependent quality indicators (QIs) for unstable angina (UA)/non-ST elevation Myocardial Infarction (NSTEMI) patients in the emergency department (ED). A retrospective, cohort study was conducted over a 42-month period of all patients aged 24 years or older suspected of having ACS as defined by receiving an electrocardiogram (ECG) and at least one cardiac biomarker test. Cox regression was used to model the effects of patient characteristics, ancillary service utilization, staffing provisions, equipment availability and ED and hospital crowding on ACS QIs. ED adherence rates to national standards for ECG read out time and biomarker turn-around-time were 42% and 37%, respectively. Cox regression models revealed that chief complaints without chest pain and the timing of stress testing and medication administration were associated with the most significant delays. Patient and system factors both significantly influenced QI times in this UA/NSTEMI cohort. These results illustrate both the complexity of diagnosing NSTEMI patients and the competing effects of clinical and system factors on patient flow through the ED.