Implementation of Rapid Response Flow Reduces the Waiting Time of Patients with Chest Pain in an Emergency Unit
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 4, Issue 2
Abstract
Introduction: Chest pain (CP) is a frequent symptom in emergencies worldwide, presenting as a diagnostic challenge for the emergency room, due to the multiplicity of etiologies, and the diagnostic fluctuation between low and high-risk diseases. The optimized door-to-ECG time is a target and excellent index to be reached in the approach of the patient with TD. Rapid inflow to the hospital until the first EGG can be performed can accelerate the diagnosis and therapy in the patient with DT by determining a risk minimization. Objective: To evaluate the impact of insertion of a rapid inflow of patients with chest pain in emergency on optimization ECG time. Method: Door-to-ECG time was evaluated before and after the insertion of a rapid inflow of the patient with CP to the hospital until the first ECG was performed. Results: ECG-Gate Time was evaluated in 199 service bulletins, 105 with traditional flow and 94 with a rapid flow of care for DT. Door-to- ECG Time was 63 minutes using traditional flow, with rapid flow there was a significant reduction of mean door-to-ECG time to 23.31 minutes in all shifts, a general reduction of 63% (p <0.001), the daytime period decreased by 61% (p <0.001) and the nocturnal period decreased by 63% (p <0.001). Conclusion: A rapid flow to optimize the door-to-ECG time allowed a significant reduction of the time of approach of the patient with CP with only two months of training of the multiprofessional team. Chest Pain (CP) corresponds to one of the most frequent symptoms in the emergency units worldwide and represents a great challenge for all the professionals who work in emergency care services, considering the multiplicity of possible diagnoses and the fluctuation between situations of low and high risk, requiring the emergencista an additional ability to diagnose fast and direct a specific and safe therapy for each case [1-6]. The traditional approach to patients in emergency units in Brazil follows the severity screening approach proposed by the Manchester protocol [7] which, in many cases, may underestimate the severity of the patient with CP, a fact due to the variation in intensity of presentation clinic of severe patients as occurs in acute coronary syndrome. The implementation of a flow directed to CP approach allows to identify and optimize care in severe patients in a fast way, making the approach safer for patients and medical staff. The insertion of protocols and the training process of the team have a direct repercussion in accelerating arrival times, diagnosis, treatment and therefore in reducing the risks of the patient with CP [8,9]. Some indexes guide the measurement of the delay time and, consequently, the efficacy in the evaluation of a patient with CP, among them, door-to-ECG time, a measure that evaluates the time between the patient’s arrival at the hospital reception to the filling of the recording protocol until the first electrocardiogram (ECG) was performed [9-12]. The door-to-ECG time considered ideal is 10 minutes, a real agility challenge for the teams of an emergency unit. [13,14] The objective of the study was to implement a protocol with a rapid care flow at the entrance of patients with CP within the emergency unit.
Authors and Affiliations
Marlon M Vilagra, Sandra Maria B Werneck, Bárbara Hang Loss, André Dias Lima Bonfim, Eduado Jannuzi Cunha, Leandra Duarte Bastos, Lahís Werneck Vilagr, Henrik Werneck Vilagra, Marco Orsini, Eduardo Tavares Lima Trajano
Keywords
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- EP ID EP590910
- DOI 10.26717/BJSTR.2018.04.001035
- Views 202
- Downloads 0
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