Not All STEMI Patients Receive Timely Reperfusion: Considerations for Rural Emergency Departments

Helen Orvad,1 Lindsay Savage,2 Tony Smith,3 Mohammad Hamiduzzaman,3 David Schmidt4 1Hunter New England Local Health District, Tamworth, NSW, Australia; 2Hunter New England Local Health District, Newcastle, NSW, Australia; 3University of Newcastle Department of Rural Health, Taree, NSW, Australia; 4H...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Orvad H, Savage L, Smith T, Hamiduzzaman M, Schmidt D
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	coronary care rural emergency thrombolysis Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/e86901a47e404f0c8707d1601a70c8ef
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:e86901a47e404f0c8707d1601a70c8ef
record_format	dspace
spelling	oai:doaj.org-article:e86901a47e404f0c8707d1601a70c8ef2021-11-07T18:42:57ZNot All STEMI Patients Receive Timely Reperfusion: Considerations for Rural Emergency Departments1178-2390https://doaj.org/article/e86901a47e404f0c8707d1601a70c8ef2021-11-01T00:00:00Zhttps://www.dovepress.com/not-all-stemi-patients-receive-timely-reperfusion-considerations-for-r-peer-reviewed-fulltext-article-JMDHhttps://doaj.org/toc/1178-2390Helen Orvad,1 Lindsay Savage,2 Tony Smith,3 Mohammad Hamiduzzaman,3 David Schmidt4 1Hunter New England Local Health District, Tamworth, NSW, Australia; 2Hunter New England Local Health District, Newcastle, NSW, Australia; 3University of Newcastle Department of Rural Health, Taree, NSW, Australia; 4Health Education and Training Institute, Australia Health Education and Training Institute, Sydney, NSW, AustraliaCorrespondence: Tony SmithUniversity of Newcastle Department of Rural Health, Taree, NSW, 2430, AustraliaTel +61+2+4055 1912Email tony.smith@newcastle.edu.auAbstract: Early reperfusion for ST-elevation myocardial infarction (STEMI) is well known to improve patient outcomes. A review of patient records in one rural health service in New South Wales, Australia, suggested that not all STEMI patients were receiving timely reperfusion. Consequently, the aim of this study was to further investigate factors influencing clinical decision making by primary care providers in relation to rural STEMI patients. This cross-sectional observational study was in two phases, a retrospective audit of patient records and a survey of rural general practitioners (GPs). In the first phase, patients with STEMI who were referred from small rural hospitals to a regional hospital emergency department (ED) were identified through the local health district database. In phase two, information from the database informed questions for a survey distributed to the GP visiting medical officers (VMOs) at small rural hospitals in the region. The survey was designed to ascertain factors that may contribute to delays in the care of STEMI patients. Of the STEMI patients identified (n = 139), 15% (21) who were eligible for medical reperfusion were not administered thrombolysis within 4 hours of triage. Auditing of this group’s records found that ECGs were inaccurately interpreted for 76% of the missed STEMI patients. In the survey, about 55% of the GP respondents said they “very much agree” with the statement that they felt competent in STEMI management. Only 64% of the GP VMOs agreed they felt competent in diagnosis and management of a failed thrombolysis and not all respondents were aware of the relevant clinical guideline. Patients with missed STEMI are at higher risk of morbidity and mortality and increased length of stay, adding burden to the patient, carer and health service. Without addressing gaps in service provision and better adherence to clinical guidelines, unacceptable delays in STEMI management in rural health services are likely to continue.Keywords: coronary care, rural, emergency, thrombolysisOrvad HSavage LSmith THamiduzzaman MSchmidt DDove Medical Pressarticlecoronary careruralemergencythrombolysisMedicine (General)R5-920ENJournal of Multidisciplinary Healthcare, Vol Volume 14, Pp 3103-3108 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	coronary care rural emergency thrombolysis Medicine (General) R5-920
spellingShingle	coronary care rural emergency thrombolysis Medicine (General) R5-920 Orvad H Savage L Smith T Hamiduzzaman M Schmidt D Not All STEMI Patients Receive Timely Reperfusion: Considerations for Rural Emergency Departments
description	Helen Orvad,1 Lindsay Savage,2 Tony Smith,3 Mohammad Hamiduzzaman,3 David Schmidt4 1Hunter New England Local Health District, Tamworth, NSW, Australia; 2Hunter New England Local Health District, Newcastle, NSW, Australia; 3University of Newcastle Department of Rural Health, Taree, NSW, Australia; 4Health Education and Training Institute, Australia Health Education and Training Institute, Sydney, NSW, AustraliaCorrespondence: Tony SmithUniversity of Newcastle Department of Rural Health, Taree, NSW, 2430, AustraliaTel +61+2+4055 1912Email tony.smith@newcastle.edu.auAbstract: Early reperfusion for ST-elevation myocardial infarction (STEMI) is well known to improve patient outcomes. A review of patient records in one rural health service in New South Wales, Australia, suggested that not all STEMI patients were receiving timely reperfusion. Consequently, the aim of this study was to further investigate factors influencing clinical decision making by primary care providers in relation to rural STEMI patients. This cross-sectional observational study was in two phases, a retrospective audit of patient records and a survey of rural general practitioners (GPs). In the first phase, patients with STEMI who were referred from small rural hospitals to a regional hospital emergency department (ED) were identified through the local health district database. In phase two, information from the database informed questions for a survey distributed to the GP visiting medical officers (VMOs) at small rural hospitals in the region. The survey was designed to ascertain factors that may contribute to delays in the care of STEMI patients. Of the STEMI patients identified (n = 139), 15% (21) who were eligible for medical reperfusion were not administered thrombolysis within 4 hours of triage. Auditing of this group’s records found that ECGs were inaccurately interpreted for 76% of the missed STEMI patients. In the survey, about 55% of the GP respondents said they “very much agree” with the statement that they felt competent in STEMI management. Only 64% of the GP VMOs agreed they felt competent in diagnosis and management of a failed thrombolysis and not all respondents were aware of the relevant clinical guideline. Patients with missed STEMI are at higher risk of morbidity and mortality and increased length of stay, adding burden to the patient, carer and health service. Without addressing gaps in service provision and better adherence to clinical guidelines, unacceptable delays in STEMI management in rural health services are likely to continue.Keywords: coronary care, rural, emergency, thrombolysis
format	article
author	Orvad H Savage L Smith T Hamiduzzaman M Schmidt D
author_facet	Orvad H Savage L Smith T Hamiduzzaman M Schmidt D
author_sort	Orvad H
title	Not All STEMI Patients Receive Timely Reperfusion: Considerations for Rural Emergency Departments
title_short	Not All STEMI Patients Receive Timely Reperfusion: Considerations for Rural Emergency Departments
title_full	Not All STEMI Patients Receive Timely Reperfusion: Considerations for Rural Emergency Departments
title_fullStr	Not All STEMI Patients Receive Timely Reperfusion: Considerations for Rural Emergency Departments
title_full_unstemmed	Not All STEMI Patients Receive Timely Reperfusion: Considerations for Rural Emergency Departments
title_sort	not all stemi patients receive timely reperfusion: considerations for rural emergency departments
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/e86901a47e404f0c8707d1601a70c8ef
work_keys_str_mv	AT orvadh notallstemipatientsreceivetimelyreperfusionconsiderationsforruralemergencydepartments AT savagel notallstemipatientsreceivetimelyreperfusionconsiderationsforruralemergencydepartments AT smitht notallstemipatientsreceivetimelyreperfusionconsiderationsforruralemergencydepartments AT hamiduzzamanm notallstemipatientsreceivetimelyreperfusionconsiderationsforruralemergencydepartments AT schmidtd notallstemipatientsreceivetimelyreperfusionconsiderationsforruralemergencydepartments
_version_	1718443321795280896

Not All STEMI Patients Receive Timely Reperfusion: Considerations for Rural Emergency Departments

Ejemplares similares