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Effectiveness of a multidisciplinary critical pathway based on a computerised physician order entry system for ST-segment elevation myocardial infarction management in the emergency department: a retrospective observational study

 Yoo Seok Park  ;  Sung Phil Chung  ;  Je Sung You  ;  Min Joung Kim  ;  Hyun Soo Chung  ;  Jung Hwa Hong  ;  Hye Sun Lee  ;  Jinwon Wang  ;  Incheol Park 
 BMJ OPEN, Vol.6(8) : 011429, 2016 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Critical Pathways* ; Disease Management ; Emergency Service, Hospital* ; Female ; Hospital Mortality ; Humans ; Length of Stay ; Male ; Medical Order Entry Systems* ; Middle Aged ; Patient Care Team ; Retrospective Studies ; ST Elevation Myocardial Infarction/diagnosis ; ST Elevation Myocardial Infarction/therapy* ; Time Factors ; Treatment Outcome
acute myocardial infarction ; computerized physician order entry system ; critical pathway ; emergency medicine ; weekend effect
OBJECTIVES: The purpose of this study was to investigate whether a multidisciplinary organised critical pathway (CP) for ST-segment elevation myocardial infarction (STEMI) management can significantly attenuate differences in the duration from emergency department (ED) arrival to evaluation and treatment, regardless of the arrival time, by eliminating off-hour and weekend effects.

DESIGN: Retrospective observational cohort study.

SETTING: 2 tertiary academic hospitals.

PARTICIPANTS: Consecutive patients in the Fast Interrogation Rule for STEMI (FIRST) program.

INTERVENTIONS: A study was conducted on patients in the FIRST program, which uses a computerised physician order entry (CPOE) system. The patient demographics, time intervals and clinical outcomes were analysed based on the arrival time at the ED: group 1, normal working hours on weekdays; group 2, off-hours on weekdays; group 3, normal working hours on weekends; and group 4, off-hours on weekends.

PRIMARY AND SECONDARY OUTCOME MEASURES: Clinical outcomes categorised according to 30-day mortality, in-hospital mortality and the length of stay.

RESULTS: The duration from door-to-data or FIRST activation did not differ significantly among the 4 groups. The median duration between arrival and balloon placement during percutaneous coronary intervention did not significantly exceed 90?min, and the proportions (89.6-95.1%) of patients with door-to-balloon times within 90?min did not significantly differ among the 4 groups, regardless of the ED arrival time (p=0.147). Moreover, no differences in the 30-day (p=0.8173) and in-hospital mortality (p=0.9107) were observed in patients with STEMI.

CONCLUSIONS: A multidisciplinary CP for STEMI based on a CPOE system can effectively decrease disparities in the door-to-data duration and proportions of patients with door-to-balloon times within 90?min, regardless of the ED arrival time. The application of a multidisciplinary CP may also help attenuate off-hour and weekend effects in STEMI clinical outcomes.
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1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Min Joung(김민정) ORCID logo https://orcid.org/0000-0003-1634-5209
Park, Yoo Seok(박유석) ORCID logo https://orcid.org/0000-0003-1543-4664
Park, In Cheol(박인철) ORCID logo https://orcid.org/0000-0001-7033-766X
Wang, Jinwon(왕진원)
You, Je Sung(유제성) ORCID logo https://orcid.org/0000-0002-2074-6745
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Chung, Sung Phil(정성필) ORCID logo https://orcid.org/0000-0002-3074-011X
Chung, Hyun Soo(정현수) ORCID logo https://orcid.org/0000-0001-6110-1495
Hong, Jung Hwa(홍정화)
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