Impact of delay in admission on the outcome of critically ill patients presenting to the emergency department of a tertiary care hospital from low income country.

OBJECTIVE: To assess the impact of admission delay on the outcome of critical patients. METHODS: The retrospective chart review was done at Aga Khan University Hospital, Karachi, and comprised adult patients visiting the Emergency Department during 2010. Outcome measures assessed were total hospital length of stay, total cost of the visit and in-hospital mortality. Patients admitted within 6 hours of presentation at Emergency Department were defined as non-delayed. Data was analysed using SPSS 19. RESULTS: Of the 49,532 patients reporting at the Emergency Department during the study period, 17,968 (36.3%) were admitted. Of them 2356(13%) were admitted to special or intensive care units, 1595(67.7%) of this sub-group stayed in the Emergency Department for >6 hours before being shifted to intensive care. The study focussed on 325(0.65%) of the total patients; 164(50.5%) in the non-delayed group and 161(49.5%) in the delayed group. The admitting diagnosis of myocardial infarction (p=0.00) and acute coronary syndrome (p=0.01) was significantly more common in the non-delayed group compared to other diagnoses like cerebrovascular attacks (p=0.03) which was significantly more common in the delayed group. There was no significant difference in the hospital length of stay between the two groups (p>0.05). The Emergency Department cost was significantly increased in the delayed group (p<0.05), but there was no difference in the overall hospital cost between the groups (p>0.05). CONCLUSIONS: There was no significant difference in the delayed and non-delayed groups, but long Emergency Department stays are distressing for both physicians and patients.

Time to treatment in patients of suspected acute coronary syndrome in Pakistan: a clinical audit.

OBJECTIVE: Evaluate time to treatment (TT) in suspected acute coronary syndrome (ACS) patients in the Emergency Department (ED) in Pakistan. METHODS: In this clinical audit, medical records of adult patients with suspicion of ACS visiting the ED of a tertiary care facility in Karachi from January to March of 2012 were reviewed and evaluated according to benchmarks from American College of Cardiology/American Heart Association guidelines. RESULTS: Study included 230 patients, of which 62.6% were males (n = 144). Physicians saw most patients (74.1%) in ≤10 min (min) of ED triage. ECG was performed in ≤10 min in 93 (47.7%) patients. Of the 207 patients being prescribed Aspirin, 41.9% received it in ≤10 min. Of 155 patients who were prescribed anti-coagulants (e.g., heparin), 32.9% received them in 10 min. Half of the patients requiring primary coronary intervention underwent the procedure within 90 min. CONCLUSION: Findings warrant exploring interventions to improve TT for ACS care in resource-limited settings.