Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical center.

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, =0.758), arterial access to first device (12±8 minutes vs 11±7 minutes, =0.230), or D2B times (50±32 minutes vs 52±34 minutes, =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, =0.007). There was no difference in in-hospital mortality (11% vs 8%, =0.484) or need for intra-aortic balloon pump placement (7% vs 8%, =0.793).

CONCLUSION

In academic medical centers, in-house cardiology fellow coverage during off-hours may expedite care of STEMI patients.