ABSTRACT
OBJECTIVES AND DESIGN: In order to assess the current behavioural status of patients receiving emergency cardiological treatment and the emergency services in the Piedmont Region, our Division carried out a survey of the Region's DEA and first aid centres based on the compilation of a questionnaire for each patient who passed through these structures over a 5-month period. The study included only patients hospitalised within 12 hours of symptoms' onset. The questionnaire aimed to assess the time the patient took to reach a decision, the eventual call for a home visit, the type of doctor called, the time spent by the doctor, the use of either a private vehicle or of an ambulance for transport to hospital, the time taken to get to the hospital, and the overall time taken to admit the patient to the emergency cardiological ward. The statistical analysis of data was carried out using both single and multiple variables. The selection of prognostic variables was carried out using a stepwise method. RESULTS: Data presented in this study refer to 1705 records, collected in 39 Piedmontese hospitals (75% of those with DEA or First Aid Center). Patients with acute myocardial infarction were 970 (57%). A doctor was requested at home in nearly half of the cases (49.3%). There was no correlation between the type of emergency and the request for a home visit, whereas the latter varied in relation to the different geographical areas and to the patients' age. A small majority of patients used personal transport to get to the hospital (55.5%) in comparison to those using an ambulance (44.5%) (p less than 0.001). Time taken to reach a decision was related to the type of pathology (acute pulmonary edema less than acute myocardial infarction less than arrhythmia) and to geographical area; mean decision time in the overall sample was 125 +/- 158 minutes. The mean duration of doctors' intervention at home was 74 +/- 82 minutes. The mean time taken to reach the hospital using private transport was 22 minutes, and the time taken using ambulance was the same, but this should be added to the time taken for the ambulance to reach the patient (a mean total time of 15 minutes). Overall mean hospitalisation time was 192 minutes. CONCLUSIONS: The critical factors causing delay in hospitalisation time are the poor levels of health education of the population in general, and the poor activation capacity of certain peripheral parts of the National Health Service. In particular, it is worth drawing attention to the delay due to the intervention of the family doctor in the current organisational model. Doctors called from first aid stations are able to provide a more rapid intervention, but are currently unable to meet the requirements of patients needing emergency cardiological treatments. These data confirm the rationale for intervention projects in cardiological emergencies, considering on one hand that a fleet of special vehicles be created, and on the other that doctors from first aid stations be specifically trained and increasingly involved.
