Doctor of Philosophy
Health Related Sciences
Abstract PROCESS FACTORS AFFECTING REPERFUSION TIME IN PATIENTS
PRESENTING WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI) By Richard R. Wall MSRS, RT(R)(CT)(CI), RCIS
A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University.
Virginia Commonwealth University, 2020.
Dissertation Chair: Jeffrey S. Legg Ph.D. Associate Professor and Chair, Department of Radiation Sciences
An ST-segment myocardial infarction (STEMI) occurs when the blood flow to the myocardium is suddenly and completely blocked causing the myocardium to become ischemic. A STEMI is a life-threatening condition that necessitates emergent medical treatment. Research has shown that longer reperfusion times are associated with negative patient outcomes. Therefore, time is critical in the treatment of a STEMI. The purpose of this study was to analyze the process factors involved with the identification and treatment of a STEMI and to develop statistical models to determine which factors have a statistically significant impact on reperfusion times at both the overall and individual facility levels.
Retrospective data, covering a three-year period, was collected from four hospitals in the Las Vegas area. A total of 647 cases were analyzed using multiple
regression analysis. The results of these analyses established overall and individual facility level models for both Door to balloon time (D2B) and First medical contact to balloon time (FMC). The results showed that the process factors Prehospital STEMI activation, Cardiologist arrival time, Lifesaving measures, Door to ECG time, Regular versus off hours, Critical diagnostics exams, and Door to first MD time all had a statistically significant impact on Door to balloon time while accounting for over 40% of the explained variance. The process factors EMS transport time, Prehospital STEMI activation, Cardiologist arrival time, Lifesaving measures, Door to ECG time, Regular versus off hours, and Critical diagnostics exams all had a statically significant impact on First medical contact to balloon times while accounting for nearly 60% of the explained variance. At the individual facility level, the process factors Prehospital STEMI activation, Door to ECG time, and cardiologist arrival time were present and accounted for significant amounts of the explained variance in nearly all models. Other statistically significant process factors that appeared in only a few models included Regular versus off hours, Lifesaving measures, Critical diagnostic exams, and Cath lab team arrival time.
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