title: Effectiveness of a multidisciplinary critical pathway based on a computerised physician order entry system for ST-segment elevation myocardial infarction management in the emergency department: a retrospective observational study.
abstract: The purpose of this study was to investigate whether a multidisciplinary organised critical pathway (CP) for ST-segment elevation myocardial infarction (STEMI) management can significantly attenuate differences in the duration from emergency department (ED) arrival to evaluation and treatment, regardless of the arrival time, by eliminating off-hour and weekend effects.
  
  
  
  Retrospective observational cohort study.
  
  
  
  2 tertiary academic hospitals.
  
  
  
  Consecutive patients in the Fast Interrogation Rule for STEMI (FIRST) program.
  
  
  
  A study was conducted on patients in the FIRST program, which uses a computerised physician order entry (CPOE) system. The patient demographics, time intervals and clinical outcomes were analysed based on the arrival time at the ED: group 1, normal working hours on weekdays; group 2, off-hours on weekdays; group 3, normal working hours on weekends; and group 4, off-hours on weekends.
  
  
  
  Clinical outcomes categorised according to 30-day mortality, in-hospital mortality and the length of stay.
  
  
  
  The duration from door-to-data or FIRST activation did not differ significantly among the 4 groups. The median duration between arrival and balloon placement during percutaneous coronary intervention did not significantly exceed 90 min, and the proportions (89.6-95.1%) of patients with door-to-balloon times within 90 min did not significantly differ among the 4 groups, regardless of the ED arrival time (p=0.147). Moreover, no differences in the 30-day (p=0.8173) and in-hospital mortality (p=0.9107) were observed in patients with STEMI.
  
  
  
  A multidisciplinary CP for STEMI based on a CPOE system can effectively decrease disparities in the door-to-data duration and proportions of patients with door-to-balloon times within 90 min, regardless of the ED arrival time. The application of a multidisciplinary CP may also help attenuate off-hour and weekend effects in STEMI clinical outcomes.
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yoo Seok
authors.initials: YS
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Phil
authors.initials: SP
authors.lastname: Chung
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Je Sung
authors.initials: JS
authors.lastname: You
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Min Joung
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Chung
authors.affiliation: Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jung Hwa
authors.initials: JH
authors.lastname: Hong
authors.affiliation: Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jinwon
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Incheol
authors.initials: I
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways; D019468:Disease Management; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D010348:Patient Care Team; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: acute myocardial infarction; computerized physician order entry system; critical pathway; emergency medicine; weekend effect