In-Hospital Emergency Treatment Delay Among Chinese Patients with Acute Ischaemic Stroke: Relation to Hospital Arrivals and Implications for Triage Pathways
Huajie Yang,1,* Zhuohua Wu,2,* Xiang Huang,3,4,* Man Zhang,3 Yu Fu,5 Yijuan Wu,2 Lei Liu,2 Yiheng Li,2 Harry HX Wang5 1School of Health Technology, Guangdong Open University (Guangdong Polytechnic Institute), Guangzhou, People’s Republic of China; 2The First Affiliated Hospit...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2023-01-01
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| Series: | International Journal of General Medicine |
| Subjects: | |
| Online Access: | https://www.dovepress.com/in-hospital-emergency-treatment-delay-among-chinese-patients-with-acut-peer-reviewed-fulltext-article-IJGM |
| _version_ | 1797955547816787968 |
|---|---|
| author | Yang H Wu Z Huang X Zhang M Fu Y Wu Y Liu L Li Y Wang HH |
| author_facet | Yang H Wu Z Huang X Zhang M Fu Y Wu Y Liu L Li Y Wang HH |
| author_sort | Yang H |
| collection | DOAJ |
| description | Huajie Yang,1,* Zhuohua Wu,2,* Xiang Huang,3,4,* Man Zhang,3 Yu Fu,5 Yijuan Wu,2 Lei Liu,2 Yiheng Li,2 Harry HX Wang5 1School of Health Technology, Guangdong Open University (Guangdong Polytechnic Institute), Guangzhou, People’s Republic of China; 2The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 3Sanxiang Community Health Service Centre of Zhongshan, Zhongshan, People’s Republic of China; 4Faculty of Medicine, Macau University of Science and Technology, Macau SAR, People’s Republic of China; 5School of Public Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Harry HX Wang, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People’s Republic of China, Tel +86 20 87330672, Email wanghx27@mail.sysu.edu.cn Yiheng Li, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People’s Republic of China, Tel +86 20 83062721, Email ehengs@qq.comIntroduction: Timely access to emergency treatment during in-hospital care phase is critical for managing the onset of acute ischaemic stroke (AIS), particularly in developing countries. We aimed to explore in-hospital emergency treatment delay and the relation of door-to-needle (DTN) time to ambulance arrivals vs walk-in arrivals.Methods: Data were collected from 1276 Chinese AIS patients admitted to a general, tertiary-level hospital for intravenous thrombolysis. Information on patients’ characteristics and time taken during in-hospital emergency treatment was retrieved from the hospital registry data and medical records. Ambulance arrival was defined as being transported by emergency ambulance services, while walk-in arrival was defined as arriving at hospital by regular vehicle. In-hospital emergency treatment delay occurred when the DTN time exceeded 60 minutes. We performed multivariable logistic regression analysis to explore the association between hospital arrivals (by ambulance vs by walk-in) and treatment delay after adjustment for age, sex, education, marital status, residence, medical insurance, number of symptoms, clinical severity and survival outcome.Results: Over half (53.76%) of patients aged over 60 years. Around one-fifth (20.61%) of patients admitted to hospital through emergency ambulance services, while their counterparts arrived by regular vehicle. Overall, the median time taken from the hospital door to treatment initiation was 86.0 minutes. Patients arrived by ambulance (adjusted odds ratio [aOR] = 1.744, 95% confidence interval [CI] = 1.185– 2.566, p = 0.005), had higher socio-economic status (aOR = 1.821, 95% CI = 1.251– 2.650; p = 0.002), or paid out-of-pocket (aOR = 2.323, 95% CI = 1.764– 3.060; p < 0.001) had an increased likelihood of in-hospital emergency treatment delays.Conclusion: In-hospital emergency treatment delay is common in China, and occurs throughout the entire emergency treatment journey. Having a triage pathway involving hospital arrival by ambulance seems to be more likely to experience in-hospital emergency treatment delay. Further efforts to improve triage pathways may require qualitative evidence on provider- and institutional-level factors associated with in-hospital emergency treatment delay.Keywords: in-hospital emergency treatment, acute ischaemic stroke, treatment delay, hospital arrival, triage pathways |
| first_indexed | 2024-04-10T23:34:52Z |
| format | Article |
| id | doaj.art-55dbeb5162bb4378a7189e7711ef1750 |
| institution | Directory Open Access Journal |
| issn | 1178-7074 |
| language | English |
| last_indexed | 2024-04-10T23:34:52Z |
| publishDate | 2023-01-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of General Medicine |
| spelling | doaj.art-55dbeb5162bb4378a7189e7711ef17502023-01-11T19:18:14ZengDove Medical PressInternational Journal of General Medicine1178-70742023-01-01Volume 16576880795In-Hospital Emergency Treatment Delay Among Chinese Patients with Acute Ischaemic Stroke: Relation to Hospital Arrivals and Implications for Triage PathwaysYang HWu ZHuang XZhang MFu YWu YLiu LLi YWang HHHuajie Yang,1,* Zhuohua Wu,2,* Xiang Huang,3,4,* Man Zhang,3 Yu Fu,5 Yijuan Wu,2 Lei Liu,2 Yiheng Li,2 Harry HX Wang5 1School of Health Technology, Guangdong Open University (Guangdong Polytechnic Institute), Guangzhou, People’s Republic of China; 2The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 3Sanxiang Community Health Service Centre of Zhongshan, Zhongshan, People’s Republic of China; 4Faculty of Medicine, Macau University of Science and Technology, Macau SAR, People’s Republic of China; 5School of Public Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Harry HX Wang, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People’s Republic of China, Tel +86 20 87330672, Email wanghx27@mail.sysu.edu.cn Yiheng Li, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People’s Republic of China, Tel +86 20 83062721, Email ehengs@qq.comIntroduction: Timely access to emergency treatment during in-hospital care phase is critical for managing the onset of acute ischaemic stroke (AIS), particularly in developing countries. We aimed to explore in-hospital emergency treatment delay and the relation of door-to-needle (DTN) time to ambulance arrivals vs walk-in arrivals.Methods: Data were collected from 1276 Chinese AIS patients admitted to a general, tertiary-level hospital for intravenous thrombolysis. Information on patients’ characteristics and time taken during in-hospital emergency treatment was retrieved from the hospital registry data and medical records. Ambulance arrival was defined as being transported by emergency ambulance services, while walk-in arrival was defined as arriving at hospital by regular vehicle. In-hospital emergency treatment delay occurred when the DTN time exceeded 60 minutes. We performed multivariable logistic regression analysis to explore the association between hospital arrivals (by ambulance vs by walk-in) and treatment delay after adjustment for age, sex, education, marital status, residence, medical insurance, number of symptoms, clinical severity and survival outcome.Results: Over half (53.76%) of patients aged over 60 years. Around one-fifth (20.61%) of patients admitted to hospital through emergency ambulance services, while their counterparts arrived by regular vehicle. Overall, the median time taken from the hospital door to treatment initiation was 86.0 minutes. Patients arrived by ambulance (adjusted odds ratio [aOR] = 1.744, 95% confidence interval [CI] = 1.185– 2.566, p = 0.005), had higher socio-economic status (aOR = 1.821, 95% CI = 1.251– 2.650; p = 0.002), or paid out-of-pocket (aOR = 2.323, 95% CI = 1.764– 3.060; p < 0.001) had an increased likelihood of in-hospital emergency treatment delays.Conclusion: In-hospital emergency treatment delay is common in China, and occurs throughout the entire emergency treatment journey. Having a triage pathway involving hospital arrival by ambulance seems to be more likely to experience in-hospital emergency treatment delay. Further efforts to improve triage pathways may require qualitative evidence on provider- and institutional-level factors associated with in-hospital emergency treatment delay.Keywords: in-hospital emergency treatment, acute ischaemic stroke, treatment delay, hospital arrival, triage pathwayshttps://www.dovepress.com/in-hospital-emergency-treatment-delay-among-chinese-patients-with-acut-peer-reviewed-fulltext-article-IJGMin-hospital emergency treatmentacute ischaemic stroketreatment delayhospital arrivaltriage pathways |
| spellingShingle | Yang H Wu Z Huang X Zhang M Fu Y Wu Y Liu L Li Y Wang HH In-Hospital Emergency Treatment Delay Among Chinese Patients with Acute Ischaemic Stroke: Relation to Hospital Arrivals and Implications for Triage Pathways International Journal of General Medicine in-hospital emergency treatment acute ischaemic stroke treatment delay hospital arrival triage pathways |
| title | In-Hospital Emergency Treatment Delay Among Chinese Patients with Acute Ischaemic Stroke: Relation to Hospital Arrivals and Implications for Triage Pathways |
| title_full | In-Hospital Emergency Treatment Delay Among Chinese Patients with Acute Ischaemic Stroke: Relation to Hospital Arrivals and Implications for Triage Pathways |
| title_fullStr | In-Hospital Emergency Treatment Delay Among Chinese Patients with Acute Ischaemic Stroke: Relation to Hospital Arrivals and Implications for Triage Pathways |
| title_full_unstemmed | In-Hospital Emergency Treatment Delay Among Chinese Patients with Acute Ischaemic Stroke: Relation to Hospital Arrivals and Implications for Triage Pathways |
| title_short | In-Hospital Emergency Treatment Delay Among Chinese Patients with Acute Ischaemic Stroke: Relation to Hospital Arrivals and Implications for Triage Pathways |
| title_sort | in hospital emergency treatment delay among chinese patients with acute ischaemic stroke relation to hospital arrivals and implications for triage pathways |
| topic | in-hospital emergency treatment acute ischaemic stroke treatment delay hospital arrival triage pathways |
| url | https://www.dovepress.com/in-hospital-emergency-treatment-delay-among-chinese-patients-with-acut-peer-reviewed-fulltext-article-IJGM |
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