Integrated Care Linked to Lower Door-In-Door-Out Time

Emergency medical services tied to reduced treatment time in STEMI patients needing transfer

WEDNESDAY, June 29 (HealthDay News) -- The presence of prehospital, emergency department, and emergency medical service (EMS) processes of care in hospitals which do not provide percutaneous coronary intervention (PCI) is associated with a significant reduction in the door-in-door-out times of patients with ST-segment elevation myocardial infarction (STEMI) requiring transfer to PCI hospitals, according to a study published online June 28 in Circulation: Cardiovascular Quality and Outcomes.

Seth W. Glickman, M.D., M.B.A., from the Duke University School of Medicine in Durham, N.C., and colleagues evaluated the association between prehospital, emergency department, and hospital EMS care processes implemented at non-PCI hospitals and time to reperfusion therapy for STEMI patients requiring transfer to PCI centres. Door-in-door-out times were analysed in 436 STEMI patients at 55 non-PCI hospitals before (July to September 2005) and after (January to March 2007) the implementation of standardized protocols as part of the Reperfusion of Acute Myocardial Infarction in North Carolina emergency departments (RACE) program.

The investigators found that the median door-in-door-out times among transferred patients improved significantly from 97.0 minutes before the intervention to 58.0 minutes after the intervention. Hospital, emergency department, and EMS care processes correlated independently with shorter door-in-door-out times for each additional hospital, emergency department, and EMS process (−17.7, −10.1, and −7.3, respectively). Hospitals with integrated EMS processes had the shortest median treatment times of 44 minutes, compared to 138 minutes in hospitals with non-integrated EMS systems.

"These findings highlight the need for an integrated, system-based approach to improving STEMI care, including a special focus on EMS," the authors write.

Several of the study authors disclosed financial ties with the pharmaceutical industry. The RACE program was partially funded by Genentech and Sanofi Aventis.

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