Journal article
Emergency Department Telemedicine Consults are Associated with Faster Time-to-Electrocardiogram and Time-to-Fibrinolysis for Myocardial Infarction Patients
Telemedicine journal and e-health, Vol.26(12), pp.1440-1448
12/2020
DOI: 10.1089/tmj.2019.0273
PMCID: PMC7864109
PMID: 32109200
Abstract
Acute myocardial infarction (AMI) is a time-sensitive condition. Meeting guideline-recommended time metrics for these patients can be challenging in rural emergency departments (EDs). Telemedicine has been shown to improve the quality and timeliness of emergency care in rural areas. The objective of this study was to evaluate the impact of telemedicine on the timeliness of emergency AMI care for patients presenting to rural EDs with chest pain.
A prospective cohort study, conducted in six telemedicine networks, identified ED patients presenting with chest pain from November 2015 through December 2017. Primary exposure was telemedicine consultation during the ED visit. The primary outcome was time-to-electrocardiogram (ECG). For eligible AMI patients, secondary outcomes included: (1) fibrinolysis administered and (2) time-to-fibrinolysis. Analyses for multivariable models were conducted by using logistic regression, clustered at the hospital level.
Overall, 1,220 patients presenting with chest pain were included in the study cohort (27.1% received telemedicine). Time-to-ECG was, on average, 0.39 times (95% confidence interval [CI] -0.26 to -0.52) faster for telemedicine cases. Among eligible patients, telemedicine was associated with higher odds of fibrinolysis administration (adjusted odds ratio 7.17, 95% CI 2.48-20.49). In a sensitivity analysis excluding patients with cardiac arrest, time-to-fibrinolysis administration did not differ when telemedicine was used.
In telemedicine networks, telemedicine consultation during the ED visit was associated with improved timeliness of ECG evaluation and increased use of fibrinolytic reperfusion therapy for rural AMI patients. Future work should focus on the impact of telemedicine consultation on patient-centered outcomes.
Details
- Title: Subtitle
- Emergency Department Telemedicine Consults are Associated with Faster Time-to-Electrocardiogram and Time-to-Fibrinolysis for Myocardial Infarction Patients
- Creators
- Aspen C Miller - Department of Emergency Medicine, Iowa City, Iowa, USAMarcia M Ward - Department of Health Management and Policy, Division of Critical Care, College of Public Health University of Iowa, Iowa City, Iowa, USAFred Ullrich - Department of Health Management and Policy, Division of Critical Care, College of Public Health University of Iowa, Iowa City, Iowa, USAKimberly A S Merchant - Department of Health Management and Policy, Division of Critical Care, College of Public Health University of Iowa, Iowa City, Iowa, USAMorgan B Swanson - Department of Epidemiology, Division of Critical Care, College of Public Health University of Iowa, Iowa City, Iowa, USANicholas M Mohr - Department of Anesthesia Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- Telemedicine journal and e-health, Vol.26(12), pp.1440-1448
- DOI
- 10.1089/tmj.2019.0273
- PMID
- 32109200
- PMCID
- PMC7864109
- NLM abbreviation
- Telemed J E Health
- ISSN
- 1530-5627
- eISSN
- 1556-3669
- Grant note
- K08 HS025753 / AHRQ HHS T32 GM007337 / NIGMS NIH HHS
- Language
- English
- Date published
- 12/2020
- Academic Unit
- Rural Telehealth Research Center; Health Management and Policy; Epidemiology; Emergency Medicine; Orthopedics and Rehabilitation; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984214828402771
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