The outcomes of emergency pharmacist participation during acute myocardial infarction.

MedStar author(s):
Citation: Journal of Emergency Medicine. 42(4):371-8, 2012 Apr.PMID: 20813484Institution: MedStar Washington Hospital CenterDepartment: Emergency MedicineForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, N.I.H., Extramural | Research Support, Non-U.S. Gov'tSubject headings: *Angioplasty, Balloon, Coronary | *Emergency Service, Hospital/og [Organization & Administration] | *Myocardial Infarction/th [Therapy] | *Patient Care Team/og [Organization & Administration] | *Pharmacy Service, Hospital/og [Organization & Administration] | Acute Disease | Adult | Aged | Emergency Service, Hospital/sn [Statistics & Numerical Data] | Female | Humans | Male | Middle Aged | Multivariate Analysis | Retrospective Studies | Time FactorsLocal holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0736-4679
Name of journal: The Journal of emergency medicineAbstract: BACKGROUND: Current guidelines recommend door-to-balloon times of 90 min or less for patients presenting to the emergency department (ED) with ST-segment elevation myocardial infarction (STEMI).CONCLUSIONS: EPh presence during STEMI presentation to the ED is independently associated with a decrease in door/diagnosis-to-CCL and door-to-balloon times. Copyright 2012 Elsevier Inc. All rights reserved.METHODS: A retrospective observational cohort study of ED patients with STEMI requiring urgent cardiac catheterization was conducted. Blinded data collection included timing of ED and CCL arrival, diagnostic electrocardiogram (ECG), and balloon angioplasty. For cases diagnosed after ED arrival, diagnosis time was substituted for door time. Diagnosis was the time ST elevations were evident on serial ECG. EPh present and not-present groups were compared. During the study period there were two EPhs and presence was determined by their scheduled time in the ED. Univariate and multivariate analyses was used to detect differences.OBJECTIVES: To determine if a clinical pharmacist for the ED (EPh) is associated with decreased door/diagnosis-to-cardiac catheterization laboratory (CCL) time and decreased door-to-balloon time.RESULTS: Multivariate analysis of 120 patients, controlled for CCL staff presence and arrival by pre-hospital services, determined that EPh presence is associated with a mean 13.1-min (95% confidence interval [CI] 6.5-21.9) and 11.5-min (95% CI 3.9-21.5) decrease in door/diagnosis-to-CCL and door-to-balloon times, respectively. Patients were more likely to achieve a door/diagnosis-to-CCL time<= 30 min (odds ratio [OR] 3.1, 95% CI 1.3-7.8) and<= 45 min (OR 2.9, 95% CI-1.0, 8.5) and a door-to-balloon time<= 90 min (OR 1.9, 95% CI 0.7-5.5) more likely when the EPh was present.All authors: Acquisto NM, Delehanty J, Fairbanks RJ, Guido J, Haas CE, Hays DP, Nobay F, Shah MNDigital Object Identifier: Date added to catalog: 2013-09-17
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 20813484

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

BACKGROUND: Current guidelines recommend door-to-balloon times of 90 min or less for patients presenting to the emergency department (ED) with ST-segment elevation myocardial infarction (STEMI).

CONCLUSIONS: EPh presence during STEMI presentation to the ED is independently associated with a decrease in door/diagnosis-to-CCL and door-to-balloon times. Copyright 2012 Elsevier Inc. All rights reserved.

METHODS: A retrospective observational cohort study of ED patients with STEMI requiring urgent cardiac catheterization was conducted. Blinded data collection included timing of ED and CCL arrival, diagnostic electrocardiogram (ECG), and balloon angioplasty. For cases diagnosed after ED arrival, diagnosis time was substituted for door time. Diagnosis was the time ST elevations were evident on serial ECG. EPh present and not-present groups were compared. During the study period there were two EPhs and presence was determined by their scheduled time in the ED. Univariate and multivariate analyses was used to detect differences.

OBJECTIVES: To determine if a clinical pharmacist for the ED (EPh) is associated with decreased door/diagnosis-to-cardiac catheterization laboratory (CCL) time and decreased door-to-balloon time.

RESULTS: Multivariate analysis of 120 patients, controlled for CCL staff presence and arrival by pre-hospital services, determined that EPh presence is associated with a mean 13.1-min (95% confidence interval [CI] 6.5-21.9) and 11.5-min (95% CI 3.9-21.5) decrease in door/diagnosis-to-CCL and door-to-balloon times, respectively. Patients were more likely to achieve a door/diagnosis-to-CCL time<= 30 min (odds ratio [OR] 3.1, 95% CI 1.3-7.8) and<= 45 min (OR 2.9, 95% CI-1.0, 8.5) and a door-to-balloon time<= 90 min (OR 1.9, 95% CI 0.7-5.5) more likely when the EPh was present.

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