Abstract 218: Do Weekends Influence Time to Treat?
In emergency cardiovascular care, time to treat is a key system goal to improve patient outcomes. In patients experiencing ST-elevation myocardial infarction (STEMI), reducing delays requires continuous quality improvement at PCI hospitals to reduce door to balloon (D2B) times. Yet, many of the hospital operational processes are not well situated to accommodate variability in patient presentation patterns. In this study, we questioned whether the day of week influences time to treat, since this could have an effect on hospital staffing, personnel mix, and resource utilization. We analyzed the entire population of 1,247 STEMI patients that presented in all of the PCI facilities in Dallas County Texas during a 24-month period (2010-2012), to assess relationships between arrival patterns and treatment delays. Specifically, we examined the differences in D2B times of patients presenting on weekends versus weekdays. To control for confounding factors, we developed a robust generalized linear model (GLM) regression and relied on estimated marginal means analyses to assess the impact of weekday vs. weekend on hospital D2B, and controlled for a variety of confounding factors.
There was a statistically significant difference in the D2B times between patients who arrived at the hospital on weekends (75 minutes) compared to those who arrived on weekdays (65 minutes) (KW=48.9; df=1; p<.001). Seventy two percent of patients who arrived on weekends or holidays achieved a D2B time of <90 minutes, compared to 79.5% for those who arrived on weekdays. GLM regression results confirmed that arriving on weekends or holidays is associated with statistically significantly higher D2B time (p=0.000), controlling for confounding variables (gender, age, presence of heart failure, cardiac arrest, shock at first medical contact, EMS transportation, and cardiac cath lab activation by EMS). Based on these findings, we recommend careful evaluation and update of hospital activation protocols and staffing policies for weekends.
Author Disclosures: J.R. Langabeer: None. D. Alqusairi: None. J. DelliFraine: None. W. Segrest: None. T. Henry: None.
This research has received full or partial funding support from the American Heart Association, South Central Affiliate (Arkansas, New Mexico, Oklahoma & Texas).
- © 2014 by American Heart Association, Inc.