Sharing and Teaching Electrocardiograms to Minimize Infarction (STEMI): reducing diagnostic time for acute coronary occlusion in the emergency department - 09/10/21
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Abstract |
Background |
Limits to ST-Elevation Myocardial Infarction (STEMI) criteria may lead to prolonged diagnostic time for acute coronary occlusion. We aimed to reduce ECG-to-Activation (ETA) time through audit and feedback on STEMI-equivalents and subtle occlusions, without increasing Code STEMIs without culprit lesions.
Methods |
This multi-centre, quality improvement initiative reviewed all Code STEMI patients from the emergency department (ED) over a one-year baseline and one-year intervention period. We measured ETA time, from the first ED ECG to the time a Code STEMI was activated. Our intervention strategy involved a grand rounds presentation and an internal website presenting weekly local challenging cases, along with literature on STEMI-equivalents and subtle occlusions. Our outcome measure was ETA time for culprit lesions, our process measure was website views/visits, and our balancing measure was the percentage of Code STEMIs without culprit lesions.
Results |
There were 51 culprit lesions in the baseline period, and 64 in the intervention period. Median ETA declined from 28.0 min (95% confidence interval [CI] 15.0–45.0) to 8.0 min (95%CI 6.0–15.0). The website garnered 70.4 views/week and 27.7 visitors/week in a group of 80 physicians. There was no change in percentage of Code STEMIs without culprit lesions: 28.2% (95%CI 17.8–38.6) to 20.0% (95%CI 11.2–28.8%).
Conclusions
Our novel weekly web-based feedback to all emergency physicians was associated with a reduction in ETA time by 20 min, without increasing Code STEMIs without culprit lesions. Local ECG audit and feedback, guided by ETA as a quality metric for acute coronary occlusion, could be replicated in other settings to improve care.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Weekly ECG feedback to all physicians reduced ECG-to-Activation time by 20 min. |
• | There was no increase in Code STEMIs without culprit lesions. |
• | ECG-to-Activation time can guide quality improvement initiatives. |
Keywords : ST elevation myocardial infarction, Electrocardiography, Quality improvement
Plan
Vol 48
P. 18-32 - octobre 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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