Factors Influencing Time-Dependent Quality Indicators for Patients With Suspected Acute Coronary Syndrome

Daniel J. France, Scott Levin, R. Ding, Robin Hemphill, Jin Han, Stephan Russ, Dominik Aronsky, Matt Weinger

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Rapid risk stratification and timely treatment are critical to favorable outcomes for patients with acute coronary syndrome (ACS). Our objective was to identify patient and system factors that influence time-dependent quality indicators (QIs) for patients with unstable angina/non–ST elevation myocardial infarction (NSTEMI) in the emergency department (ED). METHODS: A retrospective, cohort study was conducted during a 42-month period of all patients 24 years or older suspected of having ACS as defined by receiving an electrocardiogram and at least 1 cardiac biomarker test. Cox regression was used to model the effects of patient characteristics, ancillary service use, staffing provisions, equipment availability, and ED and hospital crowding on ACS QIs. RESULTS: Emergency department adherence rates to national standards for electrocardiogram readout time and biomarker turnaround time were 42% and 37%, respectively. Cox regression models revealed that chief complaints without chest pain and the timing of stress testing and medication administration were associated with the most significant delays. CONCLUSIONS: Patient and system factors both significantly influenced QI times in this cohort with unstable angina/NSTEMI. These results illustrate both the complexity of diagnosing patients with NSTEMI and the competing effects of clinical and system factors on patient flow through the ED.

Original languageEnglish (US)
JournalJournal of Patient Safety
DOIs
StateAccepted/In press - Jan 11 2016

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Acute Coronary Syndrome
Hospital Emergency Service
Myocardial Infarction
Unstable Angina
Electrocardiography
Biomarkers
Chest Pain
Proportional Hazards Models
Cohort Studies
Retrospective Studies
Equipment and Supplies

ASJC Scopus subject areas

  • Leadership and Management
  • Public Health, Environmental and Occupational Health

Cite this

Factors Influencing Time-Dependent Quality Indicators for Patients With Suspected Acute Coronary Syndrome. / France, Daniel J.; Levin, Scott; Ding, R.; Hemphill, Robin; Han, Jin; Russ, Stephan; Aronsky, Dominik; Weinger, Matt.

In: Journal of Patient Safety, 11.01.2016.

Research output: Contribution to journalArticle

France, Daniel J. ; Levin, Scott ; Ding, R. ; Hemphill, Robin ; Han, Jin ; Russ, Stephan ; Aronsky, Dominik ; Weinger, Matt. / Factors Influencing Time-Dependent Quality Indicators for Patients With Suspected Acute Coronary Syndrome. In: Journal of Patient Safety. 2016.
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AU - Russ, Stephan

AU - Aronsky, Dominik

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