Crowding Does Not Adversely Affect Time to Percutaneous Coronary Intervention for Acute Myocardial Infarction in a Community Emergency Department - 16/12/11

Doi : 10.1016/j.annemergmed.2011.06.545

Ben Harris, MD ^a,^⁎ , Jeonghwan (Christian) Bai, HBSc ^a,^b, Erik B. Kulstad, MD, MS ^a
^a Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL
^b University of Medicine and Health Sciences, St. Kitts, West Indies

Address for correspondence: Ben Harris, MD

Résumé

Study objective

Multiple studies have linked emergency department (ED) crowding to delays in patient care, such as treatment with antibiotics and analgesics. Multiple studies have also demonstrated the benefit of timely percutaneous coronary intervention for patients with acute ST-segment elevation myocardial infarction (STEMI). We therefore study whether increased occupancy rates in our community ED might correlate with delays in door-to-balloon time for patients with acute STEMI who are referred for emergency percutaneous coronary intervention.

Methods

This study was a single-institution prospective observational study. For every patient arriving in our ED from June 2007 through October 2009 with acute STEMI treated with percutaneous coronary intervention, we measured the ED occupancy rate on arrival and the door-to-balloon time and determined the correlation between these variables in univariate and multivariate analyses controlling for patient characteristics, occupancy rate, times to ECG and catheter laboratory activation, and the availability of the catheterization laboratory team (in-house versus on-call).

Results

During the study period, 210 patients were treated with emergency percutaneous coronary intervention in accordance with the hospital protocol. For these patients, the mean ED occupancy rate at arrival was 127% (range 28% to 214%). The mean time to balloon inflation was 65 minutes (range 25 to 142 minutes). The time to balloon inflation did not significantly change with increasing occupancy rate in univariate analysis (Spearman's correlation −0.02; 95% confidence interval −0.13 to 0.11) or in multivariate analysis, with the only significant variable being the availability of the catheterization laboratory team in house, which was associated with reduced time to balloon inflation.

Conclusion

Times to achieve emergency percutaneous coronary intervention for acute STEMI do not correlate positively with crowding as measured by the occupancy rate in our ED.

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Plan

Introduction

Background

Importance

Goals of This Investigation

Materials and Methods

Study Design

Setting

Selection of Participants

Data Collection and Processing

Outcome Measures

Primary Data Analysis

Results

Limitations

Discussion

	Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Emergency Medicine Foundation provided support for an earlier study which eventually led to the current investigation, although no direct support for this current investigation was provided. No conflicts directly related to this manuscript, or the topic, exist.
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	Please see page 14 for the Editor's Capsule Summary of this article.
	Supervising editor: Ellen J. Weber, MD
	Author contributions: BH and EBK conceived and designed the study and drafted the article. BH, JB, and EBK performed data abstraction and analysis and provided substantial input to the final article. EBK takes responsibility for the paper as a whole.
	Publication date: Available online July 29, 2011.