Crowding Does Not Adversely Affect Time to Percutaneous Coronary Intervention for Acute Myocardial Infarction in a Community Emergency Department
Crowding Does Not Adversely Affect Time to Percutaneous Coronary Intervention for Acute Myocardial Infarction in a Community Emergency Department
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DOI：
10.1016/j.annemergmed.2011.06.545
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发表时间：
2012-01-01
影响因子：
6.2
通讯作者：
Kulstad, Erik B.
中科院分区：
文献类型：
--
作者：
Harris, Ben;Bai, Jeonghwan Christian;Kulstad, Erik B.
研究目的：多项研究将急诊科（艾德）拥挤与患者护理的延迟联系起来，例如使用抗生素和止痛剂治疗。多项研究也证明了及时经皮冠状动脉介入治疗对急性ST段抬高型心肌梗死（STEMI）患者的益处。因此，我们研究是否增加入住率在我们的社区艾德可能与延迟门到气球的时间为急性ST段抬高型心肌梗死患者谁是指紧急经皮冠状动脉intervention.Methods：这项研究是一个单一的机构前瞻性观察性研究。对于2007年6月至2009年10月期间到达我们艾德急诊室并接受经皮冠状动脉介入治疗的急性STEMI患者，我们测量了到达时的艾德入住率和到达急诊室的球囊扩张时间，并在单变量和多变量分析中确定这些变量之间的相关性，控制患者特征、入住率、ECG和导管实验室激活的时间，和导管室团队的可用性（内部与随叫随到）。结果：在研究期间，210例患者接受了紧急经皮冠状动脉介入治疗，按照医院的协议。对于这些患者，到达时的平均艾德占用率为127%（范围为28%至214%）。球囊充盈的平均时间为65分钟（范围25 - 142分钟）。在单变量分析中，球囊扩张时间不随入住率的增加而显著变化（斯皮尔曼相关系数-0.02; 95%置信区间-0.13至0.11）或多变量分析中，唯一重要的变量是内部导管插入实验室团队的可用性，这与缩短球囊充盈时间相关。根据我们ED中的入住率测量，急性STEMI患者接受紧急经皮冠状动脉介入治疗的时间与拥挤程度不呈正相关[Ann Emerg Med. 2012;59：13-17]。
Study objective: Multiple studies have linked emergency department (ED) crowding to delays in patient care, such as treatment with antibiotics and analgesics. Multiple studies have also demonstrated the benefit of timely percutaneous coronary intervention for patients with acute ST-segment elevation myocardial infarction (STEMI). We therefore study whether increased occupancy rates in our community ED might correlate with delays in door-to-balloon time for patients with acute STEMI who are referred for emergency percutaneous coronary intervention.Methods: This study was a single-institution prospective observational study. For every patient arriving in our ED from June 2007 through October 2009 with acute STEMI treated with percutaneous coronary intervention, we measured the ED occupancy rate on arrival and the door-to-balloon time and determined the correlation between these variables in univariate and multivariate analyses controlling for patient characteristics, occupancy rate, times to ECG and catheter laboratory activation, and the availability of the catheterization laboratory team (in-house versus on-call).Results: During the study period, 210 patients were treated with emergency percutaneous coronary intervention in accordance with the hospital protocol. For these patients, the mean ED occupancy rate at arrival was 127% (range 28% to 214%). The mean time to balloon inflation was 65 minutes (range 25 to 142 minutes). The time to balloon inflation did not significantly change with increasing occupancy rate in univariate analysis (Spearman's correlation -0.02; 95% confidence interval -0.13 to 0.11) or in multivariate analysis, with the only significant variable being the availability of the catheterization laboratory team in house, which was associated with reduced time to balloon inflation.Conclusion: Times to achieve emergency percutaneous coronary intervention for acute STEMI do not correlate positively with crowding as measured by the occupancy rate in our ED. [Ann Emerg Med. 2012;59:13-17.]