71 * Does triage of patients diagnosed by paramedics with ventricular tachycardia directly to arrhythmia centres improve patient care?

Abstract

Introduction: The impact of triaging patients with selected arrhythmia emergencies diagnosed by ambulance paramedics directly to centres capable of delivering specialist care 24 hrs a day (24/7) has not been measured. Triage of patients diagnosed by the London Ambulance Service (LAS) with ventricular tachycardia (VT) directly to arrhythmia centres was evaluated and compared to standard care. Methods: Seven hospitals across London were accredited as arrhythmia centres, capable of delivering consultant led specialist care 24/7. ECG criteria for the diagnosis of VT were developed and reinforced at an education event for paramedics. A pilot study evaluated outcome for patients triaged with VT to four arrhythmia centres. Comparison groups comprised patients across London not triaged, and received by arrhythmia and non-arrhythmia centres. Results: During six months in 2013, 47 patients were triaged with VT. The diagnosis was confirmed in 30 patients (64%). The commonest misdiagnosis was atrial fibrillation (8 patients, 17%). For the 17 patients incorrectly triaged, one patient underwent emergency coronary intervention, and one patient ablation for supraventricular tachycardia. The median length of stay for this group was one day. 76 patients were admitted with VT but not triaged. The table below gives information on outcome for the triaged and non-triaged patients with VT. Conclusions: LAS paramedics diagnosed VT accurately. Where atrial arrhythmias were triaged as VT, specialist are was received and patients discharged rapidly. A sigificant minority of triaged patients required urgent coronary intervention. Many patients received by arrhythmia centres with VT underwent specialist arrhythmia interventions, and nearly half the patients received by non-arrhythmia centres required transfer for specialist care. These findings support ongoing triage for patients diagnosed by LAS paramedics with VT. The co-location of arrhythmia and coronary intervention services is supported. Ongoing LAS paramedic education, review and refinement of ECG criteria for VT should be undertaken. | | VT triaged to arrhythmia centre | VT received by arrhythmia centre (not triaged) | VT received by non-arrhythmia centre | | ----------------------------- | ------------------------------- | ---------------------------------------------- | ------------------------------------ | | No | 30 | 37 | 39 | | Acute coronary syndrome (%) | 3 (10) | | 0 (5 urgent angiograms) | | Pts transferred (%) | | | 18 (46) | | Time to transfer | N/A | N/A | 3 days | | ICD implant/VT ablation (%) | 12/5 (53) | 13/7 (57) | 6 local ICD implant (15) | | Major complications (%) | 2 (12) | 1 (5) | | | Length of stay (days, median) | 5 | 9 | 7* | * *patients not transferred (incomplete data)