IMPACT OF DATA FEEDBACK IMPLEMENTATION FOR IMPROVING DOOR-IN-DOOR-OUT TIME IN PATIENTS PRESENTING WITH ST-ELEVATION MYOCARDIAL INFARCTION TO EMERGENCY DEPARTMENT.

Mohammad Noh LATIP¹, Linawati JUMAT¹,  Li Ling CHAW².

¹Emergency Department, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, Brunei.

²PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei.

ABSTRACT
Background: In a non-PCI capable hospital, it is important to transfer patients within 30 minutes of recommended door-in-door-out (DIDO) time to reduce STEMI patient mortality. Introducing data feedback of STEMI transfers to emergency doctors is one key strategy to improve efficiency and timely transfer. This study aims to evaluate the effect of implementing monthly departmental data-feedback on reducing DIDO transfer time. Methods: A 2-phase quantitative interventional study was performed at the emergency department, RIPAS Hospital for 12 months, where DIDO time was used as the primary end point. Data was first extracted from the electronic health care records for the first 6 months, and then monthly data feedback regarding DIDO time was introduced for the next 6 months. DIDO time difference analysis was conducted between these 2 phases. Results: A total of 59 patients were enrolled, where 25 (42.4%) and 34 (57.6%) were in the pre- and post- intervention groups, respectively. Their mean age was 49.7 years and 89.9% were male.  The median DIDO time in the pre-intervention group was 40 minutes. We found a modest DIDO time improvement to 39 minutes in the post-intervention group (p = 0.784). There was a 2% increase of STEMI patients being transferred within the recommended DIDO time. Conclusion: Data feedback of STEMI transfer is a simple intervention that can be utilised to improve awareness among emergency doctors in reducing transfer delays. Identifying the cause of delays, organising system improvement and providing continuous data feedback are all important to improve timely patient transfer.

Keywords: Emergency department, Efficiency, Percutaneous coronary intervention, Quality improvement, ST Elevation myocardial infarct.

Corresponding author: Chaw, Li Ling, PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong, Brunei Darussalam.

Email: liling.chaw@ubd.edu.bn

Brunei Int Med J.2021;17:102-1081