Accuracy of manchester triage system and delay in care of patients with of acute myocardial infarction

Abstract

Background: Coronary acute disease is, because of its prevalence, morbidity and mortality, an emergency medical situation that justifies a planned intervention of Emergency Medicine. Coronary Green Way, name usually used in Portugal to nominate Rapid Response Systems (RRS), is an organized strategy that aims to improve patients' accessibility in the acute phase to more suitable medical cares, diagnosis and treatment. The time factor is critical in Acute Coronary Syndrome (ACS), since half of the deaths occur in the first hours after onset of symptoms. The sooner you start the treatment, the better the chances of survival. Objective: To evaluate the effectiveness of the RRS in classifying ACS patients and its effect on in-hospital delay (IHD). Methods: It is a quantitative cross-sectional study. We retrospectively evaluated all the patients with ACS admitted to the Coronary Care Unit through the Emergency Department (ER) of the Hospital Center, Viseu in the first nine months of 2010. Patients were divided into two groups according to RRS (Group 1: referenced by RRS; Group 2: not referenced by RRS). We compared the groups in terms of clinical and demographic characteristics, triage time (TT), door-to-ECG time (DET), medical-ECG time (MET), and door-to-balloon time (DBT); We studied 204 patients with a mean age of 69,8+/-12,7 years, 143 (70,1%) were male. Of the patients referred by RRS: Type of ACS: 35,4% of patients had ST-elevation myocardial infarction (STEMI), 44,9% had AMI without ST elevation, 19,7% with unstable angina; As for the accomplished treatment, 60,3% was primary-Percutaneous Coronary Intervention and 39,7% underwent fibrinolysis. Results: Group 1 was consisted of 147 patients (72,1%) and Group 2 of 57 (27,9%). No significant differences were observed between the two groups regarding clinical and demographic characteristics. Patients in Group 1 had average times lower than those in Group 2, as the TT (p=0,005), DET (p=0,000), MET (p=0,000) and DBT (p=0,000). Conclusion: It is intended, through the RRS, to promote the improvement of access to the patient with chest pain to quick diagnostic confirmation and institution of better therapy, more appropriate to the ACS. In addition to increasing public awareness about the need to seek a doctor immediately after the onset of ACS, using an ambulance as a direct transportation to the acute hospital is fundamental a collaborative model between the ER and Cardiology/Cardiac catheterization. Only in this way it is possible to translate <<time is tissue>> and <<time is life>>.