Neuenschwander James F, Peacock W Frank, Migeed Madgy, Hunter Sara A, Daughtery John C, McCleese Ian C, Hiestand Brian C
Department of Emergency Medicine, Genesis Health Care Systems, Zanesville, OH, USA.
Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
Clin Exp Emerg Med. 2016 Dec 30;3(4):239-244. doi: 10.15441/ceem.15.118. eCollection 2016 Dec.
Patients with implanted cardiac devices may wait extended periods for interrogation in emergency departments (EDs). Our purpose was to determine if device interrogation could be done safely and faster by ED staff.
Prospective randomized, standard therapy controlled, trial of ED staff device interrogation vs. standard process (SP), with 30-day follow-up. Eligibility criteria: ED presentation with a self-report of a potential device related complaint, with signed informed consent. SP interrogation was by company representative or hospital employee.
Of 60 patients, 42 (70%) were male, all were white, with a median (interquartile range) age of 71 (64 to 82) years. No patient was lost to follow up. Of all patients, 32 (53%) were enrolled during business hours. The overall median (interquartile range) ED vs. SP time to interrogation was 98.5 (40 to 260) vs. 166.5 (64 to 412) minutes (P=0.013). While ED and SP interrogation times were similar during business hours, 102 (59 to 138) vs. 105 (64 to 172) minutes (P=0.62), ED interrogation times were shorter vs. SP during non-business hours; 97 (60 to 126) vs. 225 (144 to 412) minutes, P=0.002, respectively. There was no difference in ED length of stay between the ED and SP interrogation, 249 (153 to 390) vs. 246 (143 to 333) minutes (P=0.71), regardless of time of presentation. No patient in any cohort suffered an unplanned medical contact or post-discharge adverse device related event.
ED staff cardiac device interrogations are faster, and with similar 30-day outcomes, as compared to SP.
植入心脏设备的患者可能需要在急诊科长时间等待设备问询。我们的目的是确定急诊科工作人员是否能够安全且更快地完成设备问询。
进行前瞻性随机、标准治疗对照试验，比较急诊科工作人员进行设备问询与标准流程（SP），并进行30天随访。入选标准：因自我报告潜在的设备相关投诉而到急诊科就诊，并签署知情同意书。标准流程问询由公司代表或医院员工进行。
60例患者中，42例（70%）为男性，均为白人，年龄中位数（四分位间距）为71（64至82）岁。无患者失访。所有患者中，32例（53%）在工作时间就诊。急诊科与标准流程问询的总体时间中位数（四分位间距）分别为98.5（40至260）分钟和166.5（64至412）分钟（P = 0.013）。虽然工作时间内急诊科和标准流程的问询时间相似，分别为102（59至138）分钟和105（64至172）分钟（P = 0.62），但非工作时间急诊科的问询时间比标准流程短；分别为97（60至126）分钟和225（144至412）分钟，P = 0.002。无论就诊时间如何，急诊科问询与标准流程问询的急诊科住院时间无差异，分别为249（153至390）分钟和246（143至333）分钟（P = 0.71）。任何一组患者均未发生计划外医疗接触或出院后与设备相关的不良事件。
与标准流程相比，急诊科工作人员进行心脏设备问询更快，且30天结局相似。
