Authors (including presenting author) :
Pang CT, Lee KH, Chan YC
Affiliation :
Accident and Emergency Department, United Christian Hospital
Introduction :
24/7 primary PCI service for STEMI patients in KEC was available since 6 Jan 2020, patients who presented to AED during non-office hour (1900-0800 on weekdays, 0800-0800 on Sat/Sun/PH) were transferred to QEH for primary PCI. As “time is muscle”, traditional management approach with verification of diagnosis with stabilization of patient before PCI center notification and transfer arrangement, is likely to cause unnecessary delay in transfer. We propose a strategic workflow to optimize the use of time by AED resuscitation team, to provide a prompt and safe interhospital transfer of such patients.
Objectives :
To employ “Call first” and “Parallel team” strategies to minimize AED door-in door-out (DIDO), with an aim to improve door to balloon (D2B) time within the international recommendation of 90 minutes
Methodology :
“ Call first” strategy requires the attending emergency physician to make decision of transfer, by answering 2 simple questions during initial few minutes of case management: 1. Whether indication of primary PCI is fulfilled, and 2. Whether the patient is clinically fit for transfer. If transfer is decided, the resuscitation team will be split into two “Parallel Teams” and work simultaneously: Transfer team will notify QEH immediately for case consultation, clinical information communication and transfer arrangement, while clinical team will be responsible for patient treatment and optimization of physical condition before transfer.
Result & Outcome :
From 6Jan2020 to 21Dec2020, there were 43 cases transferred to QEH for primary PCI. Before “Call first” and “Parallel team” were adopted, the median AED door-in door-out (DIDO) time was 67 mins (Range: 38 -118 mins) and median door to balloon time (D2B) was 128 mins (range: 79 – 188 mins). After both strategies adopted, the median DIDO time was 57 mins (range: 37-139 mins) and D2B time was 104 mins (range 74-192 mins). There was no complication during patient transfer for the whole period.
