ABSTRACT
In Interventional Cardiology, the academic year and a new training cycle begin in July. It is unclear if patient outcomes are impacted by the time of year in the training cycle. The National Cardiovascular Data Registry collects outcomes related to percutaneous coronary interventions (PCIs). We used the database for our institution to review the relation between the time of year and patient outcomes. We performed a retrospective review of National Cardiovascular Data Registry data from 2011 to 2017. Outcomes were compared between the end (quarter 2 [Q2]) and the start of the academic year (quarter 3 [Q3]). Chi-square and Fisher's exact test was used: 1,041 (Q2) and 980 (Q3) patients underwent PCI. Patient characteristics were similar between the 2 quarters except for a higher rate of heart failure for patients in Q3 (250 [24%] vs 275 [29%], pâ¯=â¯0.03). There was no difference in overall nonfatal adverse events between Q2 and Q3 (53 [5.1%] vs 58 [5.9%], pâ¯=â¯0.41). Patients in Q3 experienced a higher incidence of stroke (1 [0.1%] vs 7 [0.7%], pâ¯=â¯0.03) and PCI risk-adjusted mortality (8.29 [0.8%] vs 18.13 [1.9%], pâ¯=â¯0.03). In conclusion, there does not appear to be a significant "July Effect" in an academic cardiac catheterization laboratory in terms of most complications with an observed higher incidence of stroke and PCI risk-adjusted mortality early in the year that may be related to a difference in the characteristics of the patient population.
Subject(s)
Percutaneous Coronary Intervention , Stroke , Cardiac Catheterization/adverse effects , Humans , Percutaneous Coronary Intervention/adverse effects , Registries , Retrospective Studies , Risk Factors , Stroke/etiology , Treatment OutcomeSubject(s)
Myocardial Infarction/therapy , Near Miss, Healthcare , Patient Discharge , Patient Readmission , Health Status , Humans , Myocardial Infarction/diagnosis , Myocardial Infarction/mortality , Patient Care Team , Program Development , Program Evaluation , Quality Improvement , Quality Indicators, Health Care , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
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, p=0.758), arterial access to first device (12±8 minutes vs 11±7 minutes, p=0.230), or D2B times (50±32 minutes vs 52±34 minutes, p=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, p=0.007). There was no difference in in-hospital mortality (11% vs 8%, p=0.484) or need for intra-aortic balloon pump placement (7% vs 8%, p=0.793). CONCLUSION: In academic medical centers, in-house cardiology fellow coverage during off-hours may expedite care of STEMI patients.
