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Does the physician in triage strategy improve door-to-balloon time for patients with STEMI?
  1. Dan Schwarzfuchs1,
  2. Sagi Shashar2,
  3. Iftach Sagy2,
  4. Victor Novack2,
  5. Vladimir Zeldetz1
  1. 1 Emergency Department, Soroka University Medical Center, Beer Sheva, Southern, Israel
  2. 2 Clinical Research Center, Soroka University Medical Center, Beer Sheva, Southern, Israel
  1. Correspondence to Sagi Shashar, Clinical Research Center, Soroka University Medical Center, Beer Sheva, Southern, Israel; sagishas{at}


Background The physician in triage (PIT) strategy was implemented in the emergency department (ED) of the Soroka University Medical Center (SUMC) to improve overcrowding and waiting time. Our objective in the current study was to assess the impact of the PIT strategy on door-to-balloon time for the treatment of acute ST-elevation myocardial infarction (STEMI).

Methods The PIT programme began on January 2016, working weekdays between 8:00 and 23:00 hours. We included patients who visited the ED and were diagnosed with STEMI, from November 2014 to February 2018. The primary outcome was improvement in door-to-balloon (D2B) time <90 min between the preintervention and postintervention period. The analysis included a comparison between the two time periods using univariate tests, a time trend analysis illustrated by the locally weighted scatterplot smoothing curves and a regression analysis using generalised estimating equation models. To determine the impact of the PIT, as opposed to other changes in the department, we stratified the population arriving after January 2016 to patients arriving during PIT hours versus patients arriving on weekends and at nights (23:00–8:00 hours).

Results In all, 415 patients met all the inclusion criteria of which 237 (57.1%) visited on weekdays 8:00–23:00 hours. The per cent of patients with D2B <90 min was 13.9% higher for postintervention versus preintervention visits (p=0.006). D2B time was significantly shorter by 9 min for postintervention visits (p=0.001). In the postintervention period, patients arriving between 8:00 and 23:00 hours on weekdays were more likely to have D2B <90 min than those arriving nights and weekends; 90/146 (61.6%) vs 47.2% (51/108), respectively, p=0.02. ORs for D2B <90 min was 2.04 (95% CI 1.06 to 3.91) for weekday visits, and 1.90 (0.88 to 4.12) for weekend and night visits.

Conclusion The PIT model in SUMC is associated with D2B reduction for patients with STEMI. To achieve further reduction, both targeted interventions should be performed and PIT strategy should be applied for full time, including nights and weekends.

  • emergency care systems, efficiency
  • emergency care systems, emergency departments
  • cardiac care, acute coronary syndrome
  • management, emergency department management
  • quality improvement

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  • Handling editor Roland Merchant

  • DS and SS contributed equally.

  • Correction notice This paper has been updated since first published to amend author name 'Iftach Sagy'.

  • Contributors VZ designed the study and supervised data collection. VN and IS provided statistical advice on study design. SS and DS drafted the manuscript, SS analysed the data and all authors contributed substantially to its revision. DS and SS take responsibility for the paper as a whole.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Soroka University Medical Center Institutional Ethics Committee (0395-17-SOR).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. The datasets of which will be used and/or analysed during the current study will be available following local Ethics Committee approval.