Improving Bedside to Departure Care in Air Transport of STEMI Patients: A Two Year Retrospective Study of Performance

2.50
Hdl Handle:
http://hdl.handle.net/10755/162390
Type:
Presentation
Title:
Improving Bedside to Departure Care in Air Transport of STEMI Patients: A Two Year Retrospective Study of Performance
Abstract:
Improving Bedside to Departure Care in Air Transport of STEMI Patients: A Two Year Retrospective Study of Performance
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:McGrath, Christopher P., RN, CFRN, EMT
P.I. Institution Name:University of North Carolina Hospitals
Title:Flight Nurse
Contact Address:803 Cricketfield Lane, Cary, NC, 27518, USA
Contact Telephone:919-966-2944
[ENA Annual Conference - Research Presentation]

Purpose: The objective of the study was to evaluate time-sensitive indicators adversely affecting performance during helicopter transport of STEMI patients from remote areas to a percutaenous coronary intervention (PCI) facility. A particular focus was to examine confounding factors that affected the time from arrival at bedside/event to the time of departure to a PCI facility.

Design: Retrospective chart audit features time-sensitive indicators (in minutes) including: (1) time dispatch received, (2) time helicopter dispatched, (3) time in route, (4) time at ôbedsideö in remote location, (5) departure time, (6) return time in route, (7) total time, (8) triage determination. Data was collected by investigators using existing data compiled from transport and patient medical records. Information was obtained from transport records of missions linked to STEMI patients.

Setting: The critical care medical transport for this academic medical center serves the citizens of North Carolina by operating two 24/7 helicopters within the state.

Participants: A two-year retrospective chart-review of 355 STEMI patients who were flown from a non-PCI facility to a referring PCI facility at an academic medical center.

Methods: Following approval from the Institutional Review Board, the investigators independently reviewed all flight/patient records from June 2006 to June 2008. From a total of 355 cardiac helicopter transport cases identified in emsCharts, 32 (11%) met the inclusionary criteria of (1) helicopter transport from a non-PCI facility to our receiving facility and (2) identification of a STEMI diagnosis from the referring physician. Mission times were analyzed to recognize indicators and to identify divergences in the system which might decrease transport times. Standard deviations were used to determine the portrayal of the variance among encounters.

Results/Outcomes: There were no deaths recorded from any of the 32 cases identified for inclusion in the study and survival analysis was unobtainable. There was a significant correlation (r=.613, p=.0001) between time spent on the ground stabilizing the patient and total mission time. The indicator with the greatest variability not subject to logistics was between ôhelicopter crew arrival at bedside and crew departure with patientö with a standard deviation of 9.5 minutes.

Implications: The time from arrival at remote bedside and subsequent transfer to a PCI-facility has the most variability. Enhancing communication times between referring agency and air medical personnel and stabilizing the patient prior to transport may be the most significant components in reducing transfer times and ensuring optimal outcomes. In this study there were significant factors originating at the referring facility that increased length of mission by prolonging time spent at the bedside. While no time delays should be the standard of care, there will always be variances based on uncontrollable extraneous incidents. However, diminished standard deviations may reflect more consistent and efficient patterns of care in transporting STEMI patients.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleImproving Bedside to Departure Care in Air Transport of STEMI Patients: A Two Year Retrospective Study of Performanceen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162390-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Improving Bedside to Departure Care in Air Transport of STEMI Patients: A Two Year Retrospective Study of Performance</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">McGrath, Christopher P., RN, CFRN, EMT</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of North Carolina Hospitals</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Flight Nurse</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">803 Cricketfield Lane, Cary, NC, 27518, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">919-966-2944</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">cmcgrath@unch.unc.edu</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Research Presentation] <br/><br/>Purpose: The objective of the study was to evaluate time-sensitive indicators adversely affecting performance during helicopter transport of STEMI patients from remote areas to a percutaenous coronary intervention (PCI) facility. A particular focus was to examine confounding factors that affected the time from arrival at bedside/event to the time of departure to a PCI facility.<br/><br/>Design: Retrospective chart audit features time-sensitive indicators (in minutes) including: (1) time dispatch received, (2) time helicopter dispatched, (3) time in route, (4) time at &ocirc;bedside&ouml; in remote location, (5) departure time, (6) return time in route, (7) total time, (8) triage determination. Data was collected by investigators using existing data compiled from transport and patient medical records. Information was obtained from transport records of missions linked to STEMI patients. <br/><br/>Setting: The critical care medical transport for this academic medical center serves the citizens of North Carolina by operating two 24/7 helicopters within the state.<br/><br/>Participants: A two-year retrospective chart-review of 355 STEMI patients who were flown from a non-PCI facility to a referring PCI facility at an academic medical center.<br/><br/>Methods: Following approval from the Institutional Review Board, the investigators independently reviewed all flight/patient records from June 2006 to June 2008. From a total of 355 cardiac helicopter transport cases identified in emsCharts, 32 (11%) met the inclusionary criteria of (1) helicopter transport from a non-PCI facility to our receiving facility and (2) identification of a STEMI diagnosis from the referring physician. Mission times were analyzed to recognize indicators and to identify divergences in the system which might decrease transport times. Standard deviations were used to determine the portrayal of the variance among encounters.<br/><br/>Results/Outcomes: There were no deaths recorded from any of the 32 cases identified for inclusion in the study and survival analysis was unobtainable. There was a significant correlation (r=.613, p=.0001) between time spent on the ground stabilizing the patient and total mission time. The indicator with the greatest variability not subject to logistics was between &ocirc;helicopter crew arrival at bedside and crew departure with patient&ouml; with a standard deviation of 9.5 minutes.<br/><br/>Implications: The time from arrival at remote bedside and subsequent transfer to a PCI-facility has the most variability. Enhancing communication times between referring agency and air medical personnel and stabilizing the patient prior to transport may be the most significant components in reducing transfer times and ensuring optimal outcomes. In this study there were significant factors originating at the referring facility that increased length of mission by prolonging time spent at the bedside. While no time delays should be the standard of care, there will always be variances based on uncontrollable extraneous incidents. However, diminished standard deviations may reflect more consistent and efficient patterns of care in transporting STEMI patients.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:23Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:23Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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