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- Title
Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical center.
- Authors
Kohan, Luke C.; Nagarajan, Vijaiganesh; Millard, Michael A.; Loguidice, Michael J.; Fauber, Nancy M.; Keeley, Ellen C.
- Abstract
<bold>Objectives: </bold>To assess if a change in our cardiology fellowship program impacted our ST elevation myocardial infarction (STEMI) program.<bold>Background: </bold>Fellows covering the cardiac care unit were spending excessive hours in the hospital while on call, resulting in increased duty hours violations. A night float fellow system was started on July 1, 2012, allowing the cardiac care unit fellow to sign out to a night float fellow at 5:30 pm. The night float fellow remained in-house until the morning.<bold>Methods: </bold>We performed a retrospective study assessing symptom onset to arrival, arterial access to first device, and door-to-balloon (D2B) times, in consecutive STEMI patients presenting to our emergency department before and after initiation of the night float fellow system.<bold>Results: </bold>From 2009 to 2013, 208 STEMI patients presented to our emergency department and underwent primary percutaneous coronary intervention. There was no difference in symptom onset to arrival (150±102 minutes vs 154±122 minutes, p=0.758), arterial access to first device (12±8 minutes vs 11±7 minutes, p=0.230), or D2B times (50±32 minutes vs 52±34 minutes, p=0.681) during regular working hours. However, there was a significant decrease in D2B times seen during off-hours (72±33 minutes vs 49±15 minutes, p=0.007). There was no difference in in-hospital mortality (11% vs 8%, p=0.484) or need for intra-aortic balloon pump placement (7% vs 8%, p=0.793).<bold>Conclusion: </bold>In academic medical centers, in-house cardiology fellow coverage during off-hours may expedite care of STEMI patients.
- Subjects
MYOCARDIAL infarction treatment; ACADEMIC medical centers; PERCUTANEOUS coronary intervention; HEALTH programs; CORONARY care units; HEALTH facilities; HOSPITAL emergency services; WORKING hours; INTEGRATED health care delivery; INTERNSHIP programs; MANAGEMENT; MEDICAL care; MEDICAL care research; MYOCARDIAL revascularization; ORGANIZATIONAL effectiveness; PATIENTS; SYSTEM analysis; TIME; TRANSLUMINAL angioplasty; EMPLOYEES' workload; DEPARTMENTS; TREATMENT effectiveness; RETROSPECTIVE studies
- Publication
Vascular Health & Risk Management, 2017, Vol 13, p139
- ISSN
1176-6344
- Publication type
journal article
- DOI
10.2147/VHRM.S132405