title: The possibility of influencing components of hospital delay time within emergency departments among patients with ST-elevation in the initial electrocardiogram.
abstract: The aim of this study was to describe the possibility of influencing components of hospital delay time within the emergency department (ED) among patients with ST-elevation on the initial electrocardiogram (ECG). Nurses recorded seven patient time points: (1) ED admission; (2) ECG recording; (3) decision by nurse/ED physician; (4) cardiologist ED arrival; (5) decision of coronary care unit (CCU) admission; (6) ED departure; (7) CCU arrival. After special training in ECG, nurses in the ED were subsequently delegated to send patients directly to the CCU if showing ST-elevation on the admission ECG without contacting either the physician in ED or the cardiologist on call (intervention). Delay times between hospital admission and admission to the CCU were evaluated during the 9 months prior to and during the 6 months after the start of this intervention. Fifty patients (66% men) participated in the first study during 3 months (prior to intervention). Patients with suspected or confirmed acute myocardial infarction (AMI) in the ED had a median delay time from ED arrival to CCU arrival of 55.5 minutes (34.5 minutes for patients with confirmed AMI; ST elevation on admission). Time interval from decision to admit to CCU and ED departure was an average of 31% of the total delay. A mean of 21% of total delay occurred between ED decision to cardiologist arrival, and 19% during the time interval from cardiologist ED arrival until decision to CCU admission. Among patients receiving thrombolysis, the median delay time from hospital admission to CCU admission was reduced from 40 minutes during the 9 months prior to start of the intervention (nurses sending patients directly to the CCU) to 22 minutes during the 6 months thereafter (p = 0.02). The largest proportion of hospital delay components for acute coronary syndrome patients occurred between the cardiologist's decision to admit to the CCU and departure from the ED, and the interval following the decision by the nurse or physician to the cardiologist ED arrival. When nurses were delegated to transfer patients with ST-elevation on admission directly to the CCU without contacting a physician, the delay time from ED admission to CCU admission was reduced by nearly 50%.
authors.affiliation: Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Berglin Blohm
authors.forename: G
authors.initials: G
authors.lastname: Nilsson
authors.forename: T
authors.initials: T
authors.lastname: Karlsson
authors.forename: J
authors.initials: J
authors.lastname: Herlitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003325:Coronary Care Units / Q000458:organization & administration*; D003657:Decision Making; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy; D010360:Patient Transfer / Q000458:organization & administration; D018570:Risk Assessment; D013548:Sweden; D017748:Time Management