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Methods
Eligible patients who were admitted across five
emergency departments (EDs) in Dublin were
recruited to the study (n = 1944; control: 972,
intervention: 972).
Results
Median baseline prehospital delay times did not
differ significantly between the groups at
baseline (Mann-Whitney U, p = 0.34) (Control:
4.28 h, 25th percentile = 1.71, 75th
percentile = 17.37; Intervention 3.96 h, 25th
percentile = 1.53, 75th percentile = 18.51). Both
groups received usual in-hospital care. In
addition, patients randomized to the
intervention group received a 40-min
individualized education session using
motivational techniques. This was reinforced
1 month later by telephone. Of the 1944, 314
(16.2%) were readmitted with ACS symptoms: 177
(18.2%) and 137 (14.1%) of the intervention and
control groups, respectively. Prehospital delay
times were again measured. Median delay time
was significantly lower in the intervention
compared to the control group (1.7 h vs. 7.1 h; ps
0.001). Appropriately, those in the intervention
group reported their symptoms more promptly
to another person (p = 0.01) and fewer consulted a
general practitioner (p = 0.02). There was no
significant difference in ambulance use (p = 0.51)
or nitrate use (p = 0.06) between the groups.
Conclusion
It is possible to reduce prehospital delay time in
ACS, but the need for renewed emphasis on
ambulance use is important.
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A Randomized Controlled Trial
to Reduce Prehospital Delay
Time in Patients With Acute
Coronary Syndrome (ACS)
Mary Mooney MSC * 2 ... Debra Moser
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https://doi.org/10.1016/j.jemermed.2013.08.114
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Abstract
Background
The literature suggests that people delay too long
prior to attending emergency departments with
acute coronary syndrome (ACS) symptoms. This
delay is referred to as prehospital delay. Patient
decision delay contributes most significantly to
prehospital delay.
Objectives
Using a randomized controlled trial, we tested an
educational intervention to reduce patient
prehospital delay in ACS and promote
appropriate responses to symptoms.
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