Annals of emergency medicine
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The national standard for door-to-balloon time is 90 minutes, as recommended by the American Heart Association/American College of Cardiology guidelines for ST-elevation myocardial infarction (STEMI). Percutaneous coronary intervention for STEMI was initiated at our institution in June 2004. Review of our door-to-balloon times revealed that we were not meeting this recommendation. We determine whether concurrent rather than serial activation of the cardiac catheterization personnel and interventional cardiologist by the emergency physician would improve door-to-balloon times in the community hospital setting. ⋯ At our community hospital, concurrent activation of the cardiac catheterization team and the interventional cardiologist by the emergency physician significantly decreases door-to-balloon time for acute STEMI.
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We hypothesize that emergency department (ED) volume and increased patient complexity are associated with lower quality of care, as measured by time to antibiotics for patients being admitted with community-acquired pneumonia. ⋯ As ED volume increases, ED patients with community-acquired pneumonia are less likely to receive timely antibiotic therapy. The effect of additional patients appears to occur even at volumes below the maximum bed capacity. Measures to ensure that quality targets are met in the ED should consider the impact of ED volume.
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We seek to evaluate how accurately the emergency physician initiates percutaneous coronary intervention for patients presenting to the emergency department (ED) with ST-segment-elevation myocardial infarction (STEMI) and the impact of emergency physician-initiated percutaneous coronary intervention on mean door-to-balloon time. ⋯ The emergency physician is able to accurately initiate percutaneous coronary intervention for ED patients presenting with STEMI independent of cardiology consultation. Emergency physician-initiated percutaneous coronary intervention significantly reduces mean door-to-balloon time for these patients.