Electronic Referral System for Transferred Patients with Acute Myocardial Infarction

Abstract

Introduction: The electronic referral system (ERS) in Taiwan was designed to improve the efficiency and quality of patient transfer through a coordinated system of care intervention by imposing mutual responsibility on medical network systems. Information regarding the effects of ERS implementation on the door-to-balloon time (DBT) in transferred patients with ST-segment elevation myocardial infarction (STEMI) is scant. Methods: Data were retrospectively collected from the emergency registry database at Tri-Service General Hospital, Taipei, between January 2012 and February 2015. Patients were categorized into before and after groups depending on the time of ERS implementation. Baseline demographics and duration at the Emergency Department were recorded and analyzed. Results: We recruited 81 and 106 patients for the before and after groups, respectively. The mean age of patients was 57.7 years and 58.4 years (P = 0.704), respectively. Patients were predominantly men in both groups (92.6% vs. 86.8%, P = 0.203). The door-to-electrocardiography and door-to-catheterization laboratory time differed significantly between the two groups. The results of the general linear model analysis for STEMI patients from networked hospitals revealed that ERS implementation is an independent risk factor for shortened DBT. The average hospital stay, hospital death, and 3-month mortality or major adverse cardiac event differed nonsignificantly between the two groups (11.1% vs. 14.2%, P = 0.823). Conclusion: ERS implementation reduced the DBT for transferred STEMI patients. A coordinated system of care intervention can improve the efficiency of managing transferred patients with STEMI.

Keywords

• Acute myocardial infarction
• door-to-balloon time
• electronic referral system