Study: ED crowding does not interfere with time to treatment for STEMI patients

One new study suggests that crowding in the ED does not necessarily prevent patients who are having ST-segment-elevation myocardial infarction (STEMI) heart attacks from receiving needed treatment quickly.1 It's an issue of some concern because data show the number of EDs in the United States is dwindling even as demand for emergency care continues to rise.

In the latest single-institution, prospective observational study, researchers at Advocate Christ Medical Center in Oak Lawn, IL, found that heart attack patients needing angioplasty to clear away blocked arteries waited an average of 65 minutes for treatment, and that the level of crowding at the hospital did not impact this wait time. Researchers report in the Annals of Emergency Medicine that, on average, the ED was filled to 127% of capacity over the course of the study period from June of 2007 to October of 2009.

However, the specific hour that patients arrived at the ED did have an impact on wait times. The STEMI patients who arrived between 6 a.m. and 6 p.m., when an angioplasty team was at the hospital, waited an average of 55 minutes for treatment. Those who arrived in the evening or on weekends, when an angioplasty team was on call, waited an average of 76 minutes for treatment. Expert guidelines suggest that patients requiring emergency angioplasty should receive the procedure within 90 minutes of arrival at the ED.

While the results of this study suggest that ED crowding had no ill effects on one group of critically ill patients, Erik Kulstad, MD, a co-author of the study, suggests that there is no doubt that such crowding is having an adverse effect overall. He points out, for example, that while patients in need of emergency heart procedures are given priority, this may well draw staff and resources away from the care of other patients. Further, it should be noted that numerous studies have found a link between ED crowding and delays in care.

Reference

  1. Harris B, Bai J, Kulstad E. Crowding does not adversely affect time to percutaneous coronary intervention for acute myocardial infarction in a community emergency department. Ann Emerg Med. 2011 July 28 {Epub ahead of print}