title: Factors Influencing Time-Dependent Quality Indicators for Patients With Suspected Acute Coronary Syndrome.
abstract: Rapid risk stratification and timely treatment are critical to favorable outcomes for patients with acute coronary syndrome (ACS). Our objective was to identify patient and system factors that influence time-dependent quality indicators (QIs) for patients with unstable angina/non-ST elevation myocardial infarction (NSTEMI) in the emergency department (ED).
  
  
  
  A retrospective, cohort study was conducted during a 42-month period of all patients 24 years or older suspected of having ACS as defined by receiving an electrocardiogram and at least 1 cardiac biomarker test. Cox regression was used to model the effects of patient characteristics, ancillary service use, staffing provisions, equipment availability, and ED and hospital crowding on ACS QIs.
  
  
  
  Emergency department adherence rates to national standards for electrocardiogram readout time and biomarker turnaround 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 cohort with unstable angina/NSTEMI. These results illustrate both the complexity of diagnosing patients with NSTEMI and the competing effects of clinical and system factors on patient flow through the ED.
authors.affiliation: From the Department of Anesthesiology, Vanderbilt Medical Center, Nashville, Tennessee.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: France
authors.affiliation: Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Scott
authors.initials: S
authors.lastname: Levin
authors.affiliation: Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Ru
authors.initials: R
authors.lastname: Ding
authors.affiliation: National Center for Patient Safety, Veterans Affairs, Ann Arbor, Michigan.
authors.forename: Robin
authors.initials: R
authors.lastname: Hemphill
authors.affiliation: Department of Emergency Medicine, Vanderbilt Medical Center, Nashville, Tennessee.
authors.forename: Jin
authors.initials: J
authors.lastname: Han
authors.affiliation: Department of Emergency Medicine, Vanderbilt Medical Center, Nashville, Tennessee.
authors.forename: Stephan
authors.initials: S
authors.lastname: Russ
authors.affiliation: Department of Emergency Medicine, Vanderbilt Medical Center, Nashville, Tennessee.
authors.forename: Dominik
authors.initials: D
authors.lastname: Aronsky
authors.affiliation: From the Department of Anesthesiology, Vanderbilt Medical Center, Nashville, Tennessee.
authors.forename: Matt
authors.initials: M
authors.lastname: Weinger
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care / Q000592:standards*; D012189:Retrospective Studies