Document Detail


Improving use of prehospital 12-lead ECG for early identification and treatment of acute coronary syndrome and ST-elevation myocardial infarction.
MedLine Citation:
PMID:  20484201     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Performance of prehospital ECGs expedites identification of ST-elevation myocardial infarction and reduces door-to-balloon times for patients receiving reperfusion therapy. To fully realize this benefit, emergency medical service performance must be measured and used in feedback reporting and quality improvement.
METHODS AND RESULTS: This quasi-experimental design trial tested an approach to improving emergency medical service prehospital ECGs using feedback reporting and quality improvement interventions in 2 cities' emergency medical service agencies and receiving hospitals. All patients age > or =30 years, calling 9-1-1 with possible acute coronary syndrome, were included. In total, 6994 patients were included: 1589 patients in the baseline period without feedback and 5405 in the intervention period when there were feedback reports and quality improvement interventions. Mean age was 66+/-17 years, and women represented 51%. Feedback and quality improvement increased prehospital ECG performance for patients with acute coronary syndrome from 76% to 93% (P=<0.0001) and for patients with ST-elevation myocardial infarction from 77% to 99% (P=<0.0001). Aspirin administration increased from 75% to 82% (P=0.001), but the median total emergency medical service run time remained the same at 22 minutes. The proportion of patients with door-to-balloon times of < or =90 minutes increased from 27% to 67% (P=0.006).
CONCLUSIONS: Feedback reports and quality improvement improved prehospital ECG performance for patients with acute coronary syndrome and ST-elevation myocardial infarction and increased aspirin administration without prehospital transport delays. Improvements in door-to-balloon times were also seen.
Authors:
Denise H Daudelin; Assaad J Sayah; Manlik Kwong; Marc C Restuccia; William A Porcaro; Robin Ruthazer; Jessica D Goetz; William M Lane; Joni R Beshansky; Harry P Selker
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulation. Cardiovascular quality and outcomes     Volume:  3     ISSN:  1941-7705     ISO Abbreviation:  Circ Cardiovasc Qual Outcomes     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-20     Completed Date:  2010-09-22     Revised Date:  2013-12-20    
Medline Journal Info:
Nlm Unique ID:  101489148     Medline TA:  Circ Cardiovasc Qual Outcomes     Country:  United States    
Other Details:
Languages:  eng     Pagination:  316-23     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / diagnosis*,  epidemiology,  therapy
Aged
Aged, 80 and over
Aspirin / therapeutic use
Early Diagnosis
Electrocardiography / utilization*
Emergency Medical Services*
Female
Humans
Male
Middle Aged
Myocardial Infarction / diagnosis*,  epidemiology,  therapy
Myocardial Reperfusion*
Practice Guidelines as Topic
Quality Assurance, Health Care
Grant Support
ID/Acronym/Agency:
U01 HL077821/HL/NHLBI NIH HHS; U01 HL077821/HL/NHLBI NIH HHS; U01 HL077821-03/HL/NHLBI NIH HHS; UC1 HS15124/HS/AHRQ HHS
Chemical
Reg. No./Substance:
R16CO5Y76E/Aspirin
Comments/Corrections

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