Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical center
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 chang...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2017-04-01
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| Series: | Vascular Health and Risk Management |
| Subjects: | |
| Online Access: | https://www.dovepress.com/impact-of-around-the-clock-in-house-cardiology-fellow-coverage-on-door-peer-reviewed-article-VHRM |
| _version_ | 1818118896104767488 |
|---|---|
| author | Kohan LC Nagarajan V Millard MA Loguidice MJ Fauber NM Keeley EC |
| author_facet | Kohan LC Nagarajan V Millard MA Loguidice MJ Fauber NM Keeley EC |
| author_sort | Kohan LC |
| collection | DOAJ |
| description | 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 (150±102 minutes vs 154±122 minutes, p=0.758), arterial access to first device (12±8 minutes vs 11±7 minutes, p=0.230), or D2B times (50±32 minutes vs 52±34 minutes, p=0.681) during regular working hours. However, there was a significant decrease in D2B times seen during off-hours (72±33 minutes vs 49±15 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 |
| first_indexed | 2024-12-11T05:01:35Z |
| format | Article |
| id | doaj.art-8932ac5e828a4591bbf89d3e2f2612ed |
| institution | Directory Open Access Journal |
| issn | 1178-2048 |
| language | English |
| last_indexed | 2024-12-11T05:01:35Z |
| publishDate | 2017-04-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Vascular Health and Risk Management |
| spelling | doaj.art-8932ac5e828a4591bbf89d3e2f2612ed2022-12-22T01:20:08ZengDove Medical PressVascular Health and Risk Management1178-20482017-04-01Volume 1313914232428Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical centerKohan LCNagarajan VMillard MALoguidice MJFauber NMKeeley ECLuke 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 (150±102 minutes vs 154±122 minutes, p=0.758), arterial access to first device (12±8 minutes vs 11±7 minutes, p=0.230), or D2B times (50±32 minutes vs 52±34 minutes, p=0.681) during regular working hours. However, there was a significant decrease in D2B times seen during off-hours (72±33 minutes vs 49±15 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 fellowhttps://www.dovepress.com/impact-of-around-the-clock-in-house-cardiology-fellow-coverage-on-door-peer-reviewed-article-VHRMdoor-to-balloon time24/7 in-house callcardiology fellow |
| spellingShingle | Kohan LC Nagarajan V Millard MA Loguidice MJ Fauber NM Keeley EC Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical center Vascular Health and Risk Management door-to-balloon time 24/7 in-house call cardiology fellow |
| title | Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical center |
| title_full | Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical center |
| title_fullStr | Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical center |
| title_full_unstemmed | Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical center |
| title_short | Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical center |
| title_sort | impact of around the clock in house cardiology fellow coverage on door to balloon time in an academic medical center |
| topic | door-to-balloon time 24/7 in-house call cardiology fellow |
| url | https://www.dovepress.com/impact-of-around-the-clock-in-house-cardiology-fellow-coverage-on-door-peer-reviewed-article-VHRM |
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