Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical center – Dove Medical Press

Luke C Kohan,1,* Vijaiganesh Nagarajan,1,* Michael A Millard,2 Michael J Loguidice,2 Nancy M Fauber,1 Ellen C Keeley1

1Division of Cardiology, 2Department of Medicine, University of Virginia, Charlottesville, VA, USA

* These authors contributed equally to this work

Objectives: To assess if a change in our cardiology fellowship program impacted our ST elevation myocardial infarction (STEMI) program. Background: Fellows covering the cardiac care unit were spending excessive hours in the hospital while on call, resulting in increased duty hours violations. A night float fellow system was started on July 1, 2012, allowing the cardiac care unit fellow to sign out to a night float fellow at 5:30 pm. The night float fellow remained in-house until the morning. Methods: We performed a retrospective study assessing symptom onset to arrival, arterial access to first device, and door-to-balloon (D2B) times, in consecutive STEMI patients presenting to our emergency department before and after initiation of the night float fellow system. Results: From 2009 to 2013, 208 STEMI patients presented to our emergency department and underwent primary percutaneous coronary intervention. There was no difference in symptom onset to arrival (150102 minutes vs 154122 minutes, p=0.758), arterial access to first device (128 minutes vs 117 minutes, p=0.230), or D2B times (5032 minutes vs 5234 minutes, p=0.681) during regular working hours. However, there was a significant decrease in D2B times seen during off-hours (7233 minutes vs 4915 minutes, p=0.007). There was no difference in in-hospital mortality (11% vs 8%, p=0.484) or need for intra-aortic balloon pump placement (7% vs 8%, p=0.793). Conclusion: In academic medical centers, in-house cardiology fellow coverage during off-hours may expedite care of STEMI patients.

Keywords: door-to-balloon time, 24/7 in-house call, cardiology fellow

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Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical center - Dove Medical Press