title: Same-day transfer for the invasive strategy of patients with non-ST-segment elevation acute coronary syndrome admitted to spoke hospitals: Data from the Emilia-Romagna Regional Network.
abstract: BACKGROUND
  The service strategy (same-day transfer between spoke hospital and hub centre with catheterisation laboratory (cath-lab) facility to perform invasive procedures) has been suggested to improve the management of patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) admitted to spoke hospitals. We used data from a large prospective Italian registry to describe application, performance and outcome of the service strategy in the daily clinical practice.
  
  
  METHODS
  This study was based on an observational, post-hoc analysis of all consecutive NSTEACS patients admitted to spoke non-invasive hospitals of the Emilia-Romagna regional network and receiving coronary artery angiography (CAA)±percutaneous coronary intervention (PCI). We evaluated: application of service strategy, time to cath-lab access, hospital stay length, 30-days occurrence of adverse events.
  
  
  RESULTS
  From January 2011-December 2012, 2952 NSTEACS consecutive patients were admitted to spoke non-invasive hospitals and received CAA. Overall, 1765 (60%) patients were managed with a service strategy. After multivariable analysis, service strategy emerged as independent predictor of faster access to cath-lab (within 72 h: hazard ratio (HR) 2.3, 95% confidence interval (CI) 1.9-2.7, p<0.0001; within 24 h: HR 2.8, 95% CI 2.2-3.3, p<0.0001, respectively). Service strategy significantly reduced hospital stay length (-5.5 days, p<0.0001). We estimated a mean of €1590 saved for each patient managed with service strategy. Thirty-day occurrence of adverse events did not differ between patients managed with or without a service strategy.
  
  
  CONCLUSIONS
  In our daily clinical practice, a service strategy seems to be an effective approach to optimise the invasive management of NSTEACS patients admitted to spoke hospitals.
authors.affiliation: Cardiovascular Institute, Azienda Ospedaliero-Universitaria S. Anna, Italy Laboratorio per le Tecnologie delle Terapie Avanzate (LTTA) Center, Italy cmpglc@unife.it.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Campo
authors.affiliation: Unità Operativa di Cardiologia, Ospedale degli Infermi, Rimini, Italy.
authors.forename: Mila
authors.initials: M
authors.lastname: Menozzi
authors.affiliation: Agenzia Sanitaria Regionale Regione Emilia-Romagna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Guastaroba
authors.affiliation: Divisione di Cardiologia, Ospedale Maggiore, Parma, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Vignali
authors.affiliation: Agenzia Sanitaria Regionale Regione Emilia-Romagna, Italy.
authors.forename: Laura Mb
authors.initials: LM
authors.lastname: Belotti
authors.affiliation: Unità Operativa di Cardiologia, Ospedale Maggiore, Bologna, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Casella
authors.affiliation: Agenzia Sanitaria Regionale Regione Emilia-Romagna, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Berti
authors.affiliation: Divisione di Cardiologia, Ospedale Maggiore, Parma, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Solinas
authors.affiliation: Unità Operativa di Cardiologia Interventistica, Ospedale S. Maria Nuova, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Guiducci
authors.affiliation: Cardiovascular Institute, Azienda Ospedaliero-Universitaria S. Anna, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Biscaglia
authors.affiliation: Cardiovascular Institute, Azienda Ospedaliero-Universitaria S. Anna, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Pavasini
authors.affiliation: Agenzia Sanitaria Regionale Regione Emilia-Romagna, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: De Palma
authors.affiliation: Unità Operativa di Cardiologia Interventistica, Ospedale S. Maria Nuova, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Manari
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000191:economics / Q000379:methods; D017046:Cost Savings; D019033:Delivery of Health Care, Integrated / Q000191:economics; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D000072658:Non-ST Elevated Myocardial Infarction / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery*; D010360:Patient Transfer; D062645:Percutaneous Coronary Intervention / Q000191:economics / Q000379:methods; D011446:Prospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Acute coronary syndrome; coronary artery angiography; percutaneous coronary intervention; same-day transfer; service strategy; spoke hospital