Predictors of transportation delay in patients with suspected ST-elevation-myocardial infarction in the VIENNA-STEMI network

Real-Time Location Systems: Revolutionizing Porter Services for Improving Patient Care Efficiency

BACKGROUND

Transport porters (TPTs) are essentially involved in supporting hospital operations and maintaining high-quality patient care. The traditional porter management lacks transmission of temporal and spatial information of the porters thus affecting porter operations. In this work, we investigate the barriers in traditional porter management and the impact of a real-time location system (RTLS) in improving time and cost efficiency for porter operations.

METHODOLOGY

A six-month study was conducted at Medanta - The Medicity, Gurugram investigating the limitations of traditional management and efficiency of indoor porter tracking system (IPTS) on TPTs operational activities by assessing the waiting time and total turnaround time (TAT). The cost-effectiveness of IPTS was determined based on capital expenditure and return on investment (ROI) post-technology implementation.

RESULTS

This study highlights that improvements are required in porter management as 175 out of 285 (62%) calls were unanswered by TPTs. Post deployment of IPTS, the TAT for A-wing was reduced from 28 minutes to 20 minutes, and for B-wing, it was reduced from 26 minutes to 18 minutes. Staff optimization of three and four porters was done for A-wing and B-wing, respectively. The capital expenditure was recovered by reduced wait time and optimization of staff, thereby anticipating a monthly saving of ₹0.18 million (US$ 2150). The effective outcome of IPTS porter management envisaged its expansion to inpatient medicine delivery with a substantial cost reduction of ₹8.0 million (US$ 96,000) over three years.

CONCLUSION

The implementation of IPTS improved the operational activities of porters and improved staff utilization. Cost savings from staff optimization lays the groundwork for new technology integrations for long-term operational advancements.

Outcomes after delayed primary percutaneous coronary intervention versus pharmaco-invasive strategy in ST-segment elevation myocardial infarction in Norway

Aims

Primary percutaneous coronary intervention (pPCI) is the preferred reperfusion strategy in patients with ST-segment elevation myocardial infarction (STEMI) provided it can be performed within 120 min from diagnosis. However, it is unclear whether pPCI or a pharmaco-invasive (P-I) strategy is the best choice in patients who cannot receive timely pPCI. The aim of the present study was to compare outcomes after delayed and late pPCI vs. a P-I strategy in STEMI patients who did not receive timely pPCI.

Methods and results

All patients with STEMI registered in the Norwegian Myocardial Infarction Registry (NORMI) between 2013 and 2019, with ≤12 h from symptom onset to first medical contact and available timelines were included in the study. The primary outcome was all-cause mortality, and follow-up was through 2019. A total of 21 121 (27% of 78 368) STEMI patients were registered in the NORMI. Among patients who met the inclusion criteria, 7238 (54%) patients underwent timely pPCI, 1537 (11%) delayed pPCI (121–180 min), 1012 (7%) late pPCI (>180 min), and 2338 (17%) patients were treated with a P-I strategy. After a median follow-up time of 2.5 years, mortality was higher in the delayed pPCI [adjusted hazard ratio (HR) 1.3, 95% confidence interval (CI) 1.0–1.5] and in the late pPCI group (adjusted HR 1.4, 95% CI 1.1–1.7) compared to the P-I strategy group, but bleeding complications were more frequent after P-I strategy.

Conclusions

In STEMI patients who did not receive timely percutaneous coronary intervention, a P-I strategy seemed to be associated with better long-term survival compared to delayed/late pPCI.

Multivessel versus culprit-only PCI in STEMI patients with multivessel disease: meta-analysis of randomized controlled trials

AIMS

To perform a pairwise meta-analysis of randomized controlled trials (RCTs) comparing multivessel percutaneous coronary intervention (PCI) and culprit vessel-only PCI in ST-elevation myocardial infarction (STEMI) patients without cardiogenic shock.

METHODS

We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase for RCTs comparing multivessel PCI with culprit vessel-only PCI in STEMI patients without cardiogenic shock and multivessel coronary artery disease. Only RCTs reporting mortality or myocardial reinfarction after at least 6 months following randomization were included. Hazard ratios (HRs) were pooled using random-effect models.

RESULTS

Nine RCTs were included in the final analysis. In total, 523 (8.3%) of 6314 patients suffered the combined primary endpoint of death or non-fatal reinfarction. This primary endpoint was significantly reduced with multivessel PCI compared to culprit vessel-only PCI (HR 0.63, 95% confidence interval [CI] 0.43-0.93; p = 0.03). This finding was driven by a reduction of non-fatal reinfarction (HR 0.64, 95% CI 0.52-0.79; p = 0.001), whereas no significant reduction of all-cause death (HR 0.77, 95% CI 0.44-1.35; p = 0.28) or cardiovascular death (HR 0.64, 95% CI 0.37-1.11; p = 0.09) was observed.

CONCLUSIONS

In STEMI patients without cardiogenic shock multivessel PCI reduced the risk of death or non-fatal reinfarction compared to culprit vessel-only PCI.