Improving STEMI management in the emergency department: Examining the role of minority groups and sociodemographic characteristics

Mor Saban, Tal Shachar, Rabia Salama, Aziz Darawsha

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To evaluate whether a fast-track intervention program will reduce time-lags of patients with STEMI considering minority groups, various socioeconomic status (SES) and clinical risk factors. Methods: A retrospective-archive study was conducted according to clinical guidelines, comparing all STEMI patients (n = 140) admitted to the emergency department (ED) before (n = 60) and during (n = 80) implementation of the fast track intervention program. The program comprised four steps: (1) immediate bed rest, (2) marking patient chart, (3) assessing time-lags according to defined clinical guidelines, and (4) physician signing a dedicated sticker on the ECG. Results: The major ethnic group compared to other minority patients with STEMI were less delayed for physician examination (r = −0.398, p < 0.01), spent less time at ED (r = −0.541, p < 0.01) and reached percutaneous coronary intervention earlier (r = −0.672, p < 0.01). Patients with higher SES spent less time for physician (r = −338, p < 0.05) and in the ED (r = −0.415, p < 0.01). Before intervention patients with diabetes mellitus (DM) spent more time at ED compared to non DM patients, however during intervention this difference was blurred (β = −0.803, p < 0.001). Gaps regarding sociodemographic bias remained present throughout the intervention despite monthly staff evaluations considering patient cases. Conclusions: The fast track intervention was associated with less time at ED and to cardiac reperfusion. Yet, sociodemographic bias was present. Our findings highlight the need for the healthcare profession to address the role of biases in disparities in healthcare.

Original languageEnglish
Pages (from-to)1102-1109
Number of pages8
JournalAmerican Journal of Emergency Medicine
Volume38
Issue number6
DOIs
StatePublished - 1 Jun 2020
Externally publishedYes

ASJC Scopus subject areas

  • Emergency Medicine

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