Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical center
OBJECTIVES: To assess if a change in our cardiology fellowship program impacted our ST elevation myocardial infarction (STEMI) program.
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSION: In academic medical centers, in-house cardiology fellow coverage during off-hours may expedite care of STEMI patients.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
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| Enthalten in: |
Vascular health and risk management - 13(2017) vom: 09., Seite 139-142 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kohan, Luke C [VerfasserIn] |
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| Links: |
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| Themen: |
24/7 in-house call |
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| Anmerkungen: |
Date Completed 12.09.2017 Date Revised 13.11.2018 published: Electronic-eCollection Citation Status MEDLINE |
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| doi: |
10.2147/VHRM.S132405 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM271443987 |
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| 245 | 1 | 0 | |a Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical center |
| 264 | 1 | |c 2017 | |
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| 500 | |a Date Completed 12.09.2017 | ||
| 500 | |a Date Revised 13.11.2018 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVES: To assess if a change in our cardiology fellowship program impacted our ST elevation myocardial infarction (STEMI) program | ||
| 520 | |a BACKGROUND: 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 | ||
| 520 | |a METHODS: 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 | ||
| 520 | |a RESULTS: 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) | ||
| 520 | |a CONCLUSION: In academic medical centers, in-house cardiology fellow coverage during off-hours may expedite care of STEMI patients | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a 24/7 in-house call | |
| 650 | 4 | |a cardiology fellow | |
| 650 | 4 | |a door-to-balloon time | |
| 700 | 1 | |a Nagarajan, Vijaiganesh |e verfasserin |4 aut | |
| 700 | 1 | |a Millard, Michael A |e verfasserin |4 aut | |
| 700 | 1 | |a Loguidice, Michael J |e verfasserin |4 aut | |
| 700 | 1 | |a Fauber, Nancy M |e verfasserin |4 aut | |
| 700 | 1 | |a Keeley, Ellen C |e verfasserin |4 aut | |
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