Evidence map›Paper›PMID 32762657›Full record

ArticleBMC emergency medicine2020

Breaking down walls: a qualitative evaluation of perceived emergency department delays for patients transferred with ST-elevation myocardial infarction.

Michael J Ward, Timothy J Vogus, Kemberlee Bonnet, Kelly Moser, David Schlundt, Sunil Kripalani

Abstract readMulticenter Study
In one paragraph

Article in BMC emergency medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Observational
  3. Article
  4. Article
  5. Effects of COVID-19 on STEMI Patients: Single-Center Experience.Heart views : the official journal of the Gulf Heart Association
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Michael J WardDepartment of Emergency Medicine, Vanderbilt University Medical Center, VA Tennessee Valley Healthcare System, 1313 21st Ave. Oxford House #330, Nashville, TN, 37203, USA. michael.j.ward@vumc.org.ORCID 0000-0002-4561-2946
Timothy J VogusCenter for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, USA.
Kemberlee BonnetDepartment of Psychology, Vanderbilt University, Nashville, USA.
Kelly MoserDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA.
David SchlundtDepartment of Psychology, Vanderbilt University, Nashville, USA.
Sunil KripalaniCenter for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, USA.

Funding

Enhancing Inter-Facility Transfer for Patients with Acute Myocardial InfarctionK23HL127130 · NHLBI · VANDERBILT UNIVERSITY MEDICAL CENTER · PI WARD, MICHAEL J. · 2016 to 2019
$642k
NHLBI NIH HHS K23 HL127130
6 · The paper itself

Abstract

backgroundDespite regionalization efforts, delays at transferring hospitals for patients transferred with ST-elevation myocardial infarction (STEMI) for primary percutaneous coronary intervention (PCI) persist. These delays primarily occur in the emergency department (ED), and are associated with increased mortality. We sought to use qualitative methods to understand staff and clinician perceptions underlying these delays.

methodsWe conducted semi-structured interviews at 3 EDs that routinely transfer STEMI patients to identify staff perceptions of delays and potential interventions. Interviews were recorded, transcribed, coded, and analyzed using an iterative inductive-deductive approach to build and refine a list of themes and subthemes, and identify supporting quotes.

resultsWe interviewed 43 ED staff (staff, nurses, and physicians) and identified 3 major themes influencing inter-facility transfers of STEMI patients: 1) Processes, 2) Communication; and 3) Resources. Standardized processes (i.e., protocols) reduce uncertainty and can mobilize resources. Use of performance benchmarks can motivate staff but are frequently focused on internal, not inter-organizational performance. Direct use ofcommunication between ORGANIZATIONS can process uncertainty and expedite care. Record sharing and regular post-transfer communication could provide opportunities to discuss and learn from delays and increase professional satisfaction. Finally, characteristics of resources that enhanced their capacity, clarity, experience, and reliability were identified as contributing to timely transfers.

conclusionsProcesses, communication, and resources were identified as modifying inter-facility transfer timeliness. Potential quality improvement strategies include ongoing updates of protocols within and between organizations to account for changes, enhanced post-transfer feedback between organizations, shared medical records, and designated roles for coordination.

Indexed as

Percutaneous Coronary InterventionTime-to-TreatmentAdultEmergency Service, HospitalFemaleHumansInterviews as TopicMalePatient TransferQualitative ResearchST Elevation Myocardial InfarctionCare coordinationEmergency medicineInter-facility transferQualitative methodsST-elevation myocardial infarction

Identifiers

PMID32762657
PMCPMC7409424

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.