Effect of the hospital transfer of STEMI patients through the remote emergency consultation system on the emergency department length of stay and survival at hospital discharge: a single center retrospective cohort study

Abstract

This study aimed to analyze and determine the effects of emergency department (ED) length of stay (LOS) and survival at hospital discharge (SHD) on patients with ST-segment elevation myocardial infarction (STEMI) treated by the Remote Emergency Consultation System (RECS), a government-led teleconsultation project. This was a retrospective cohort chart review performed at a single center. The study period was from 01 May 2015, to 31 December 2020. The RECS group was set as the intervention group among the total transferred STEMI patients, and the No-RECS group was set as the control group. Ninety-eight patients with STEMI were collectively included in the No-RECS (n = 56) and RECS (n = 42) groups. The median value of ED LOS was 31 (21, 46.5) min in the No-RECS group and 21.5 (13.25, 37.25) min in the RECS group (p = 0.0329). The variables (odds ratio (95% confidence interval (CI)); p-value) predictive of SHD in the patients with STEMI were systolic blood pressure (SBP) (1.09 (1.003, 1.19); p = 0.0413) and total hospital days (2.95 (1.05, 8.26); p = 0.0399). The optimal cut-off points (sensitivity and specificity) of the receiver operating characteristic (ROC) curve of the SBP and total hospital days to predict SHD in the patients with STEMI were (0.742, 1) 105 and (0.753, 1) 3.5, respectively. RECS was associated with a decrease in EDLOS in patients with STEMI, but showed no association with SHD. SBP at the time of the ED visit and total hospital days were positively correlated with SHD.