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  1. NTU Scholars
  2. 醫學院
  3. 醫學系
Please use this identifier to cite or link to this item: https://scholars.lib.ntu.edu.tw/handle/123456789/550806
Title: The impact of door-to-electrocardiogram time on door-to-balloon time after achieving the guideline-recommended target rate
Authors: CHIH-KUO LEE 
Meng S.-W.
Lee M.-H.
Chen H.-C.
Wang C.-L.
Wang H.-N.
MIN-TSUN LIAO 
MU YANG HSIEH 
Huang Y.-C.
EDWARD PEI-CHUAN HUANG 
CHIH-CHENG WU 
Issue Date: 2019
Publisher: Public Library of Science
Journal Volume: 14
Journal Issue: 9
Source: PLoS ONE
Abstract: 
Background Little is known about the components and contributing factors of door-to-balloon time after implementation of Door-to-Balloon Alliance quality-improving (QI) strategies, including the impact of door-to-ECG time on door-to-balloon time. Objective We investigated whether modification of emergency department (ED) triage processes could improve door-to-ECG and door-to-balloon times after implementation of QI strategies. Methods This was a retrospective before-and-after study of a prospectively collected database. From June 2014 to October 2014, interventions were implemented in our ED, including a protocol-driven ECG initiation and moving an ECG station and technician to the triage area. The primary outcome was the percentage of patients with ST-elevation myocardial infarction (STEMI) who received ECG within 10 min of arrival; the secondary outcome was the percentage of patients with door-to-balloon times of <90 min from arrival. Patients from the year pre- and post-QI initiative were defined as the control and intervention groups, respectively. Results Enrollment comprised 214 patients with STEMI: 109 before the intervention and 105 after the intervention. We analyzed the components of the door-to-balloon process and found the door-to-ECG process was the most critical interval of delay (20.8%). Unrecognized symptoms were the most common cause of delay in the door-to-ECG process resulting in a significant impact on the door-to-balloon time. The intervention group had a higher percentage of patients with door-to-ECG times <10 min than did the control group (93.3% vs. 79.8%, p = 0.005), with a corresponding improvement in door-to-balloon times <90 min (91.1% vs. 76.2%, p = 0.007). In subgroup analysis, the intervention benefits occurred only in non-transferred or walk-in patients. After adjustment for possible co-variates, the QI interventions remained a significant contributing factor for achieving the door-to-ECG and door-to-balloon targets. Conclusions The modification of ED triage processes through implementation of QI strategies are effective in achieving better door-to-ECG times and thus, achieving door-to-balloon times <90 min. In patients presenting with ambiguous symptoms, improved door-to ECG target achievement rates, through a protocol-driven and multidisciplinary approach allows for earlier identification of STEMI. ? 2019 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
URI: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85071916216&doi=10.1371%2fjournal.pone.0222019&partnerID=40&md5=0f09dd8906a2976c9d2f5f64d5018a68
https://scholars.lib.ntu.edu.tw/handle/123456789/550806
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0222019
SDG/Keyword: adult; age distribution; Article; clinical feature; clinical practice; controlled study; cost effectiveness analysis; electrocardiography; emergency care; female; health care cost; hemodynamic parameters; human; major clinical study; male; outcome assessment; patient monitoring; percutaneous coronary intervention; practice guideline; retrospective study; risk benefit analysis; sex difference; ST segment elevation myocardial infarction; therapy delay; time to treatment; university hospital; electrocardiography; emergency health service; heart infarction; hospital emergency service; middle aged; procedures; time factor; transluminal coronary angioplasty; treatment outcome; Angioplasty, Balloon, Coronary; Electrocardiography; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Myocardial Infarction; Practice Guidelines as Topic; Retrospective Studies; Time Factors; Treatment Outcome; Triage
[SDGs]SDG3
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