Staff Recall Travel Time for ST Elevation Myocardial Infarction Impacted by Traffic Congestion and Distance: A Digitally Integrated Map Software Study

Background Recent evidence suggests hospitals fail to meet guideline specified time to percutaneous coronary intervention (PCI) for a proportion of ST elevation myocardial infarction (STEMI) presentations. Implicit in achieving this time is the rapid assembly of crucial catheter laboratory staff. As a proof-of-concept, we set out to create regional maps that graphically show the impact of traffic congestion and distance to destination on staff recall travel times for STEMI, thereby producing a resource that could be used by staff to improve reperfusion time for STEMI. Methods Travel times for staff recalled to one inner and one outer metropolitan hospital at midnight, 6 p.m., and 7 a.m. were estimated using Google Maps Application Programming Interface. Computer modeling predictions were overlaid on metropolitan maps showing color coded staff recall travel times for STEMI, occurring within non-peak and peak hour traffic congestion times. Results Inner metropolitan hospital staff recall travel times were more affected by traffic congestion compared with outer metropolitan times, and the latter was more affected by distance. The estimated mean travel times to hospital during peak hour were greater than midnight travel times by 13.4 min to the inner and 6.0 min to the outer metropolitan hospital at 6 p.m. (p < 0.001). At 7 a.m., the mean difference was 9.5 min to the inner and 3.6 min to the outer metropolitan hospital (p < 0.001). Only 45% of inner metropolitan staff were predicted to arrive within 30 min at 6 p.m. compared with 100% at midnight (p < 0.001), and 56% of outer metropolitan staff at 6 p.m. (p = 0.021). Conclusion Our results show that integration of map software with traffic congestion data, distance to destination and travel time can predict optimal residence of staff when on-call for PCI.

[1]  C. Terkelsen,et al.  Distance to invasive heart centre, performance of acute coronary angiography, and angioplasty and associated outcome in out-of-hospital cardiac arrest: a nationwide study , 2017, European heart journal.

[2]  C. Terkelsen,et al.  System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention. , 2010, JAMA.

[3]  Systems of care to improve timeliness of reperfusion therapy for ST-segment elevation myocardial infarction during off hours: the Mayo Clinic STEMI protocol. , 2008, JACC. Cardiovascular interventions.

[4]  S. Z. Abildstrøm,et al.  Influence of distance from home to invasive centre on invasive treatment after acute coronary syndrome: a nationwide study of 24 910 patients , 2010, Heart.

[5]  R. Gibbons,et al.  Impact of time to treatment on myocardial reperfusion and infarct size with primary percutaneous coronary intervention for acute myocardial infarction (from the EMERALD Trial). , 2007, The American journal of cardiology.

[6]  Hadley Wickham,et al.  ggmap: Spatial Visualization with ggplot2 , 2013, R J..

[7]  C. Granger,et al.  Bypassing the Emergency Department and Time to Reperfusion in Patients With Prehospital ST-Segment–Elevation: Findings From the Reperfusion in Acute Myocardial Infarction in Carolina Emergency Departments Project , 2013, Circulation. Cardiovascular interventions.

[8]  C. Granger,et al.  Regional Systems of Care Demonstration Project: American Heart Association Mission: Lifeline STEMI Systems Accelerator. , 2016, Circulation.

[9]  M. Bell,et al.  Sustaining Improvement in Door-to-Balloon Time Over 4 Years: The Mayo Clinic ST-Elevation Myocardial Infarction Protocol , 2009, Circulation. Cardiovascular quality and outcomes.

[10]  Tranberg Infarktpatienten besser in Spezialklinik , 2017, DMW - Deutsche Medizinische Wochenschrift.

[11]  J. Ottervanger,et al.  Time-to-treatment significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute myocardial infarction treated by primary angioplasty. , 2004, European heart journal.

[12]  Richard Beare,et al.  Googling Service Boundaries for Endovascular Clot Retrieval Hub Hospitals in a Metropolitan Setting: Proof-of-Concept Study , 2017, Stroke.

[13]  V. Srikanth,et al.  Googling Service Boundaries for Endovascular Clot Retrieval (ECR) Hub Hospitals in Metropolitan Sydney , 2019, Front. Neurol..

[14]  Jane A. Linderbaum,et al.  2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. , 2013, Journal of the American College of Cardiology.

[15]  B. Brodie,et al.  Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction. , 1998, Journal of the American College of Cardiology.

[16]  Peter Dalgaard,et al.  R Development Core Team (2010): R: A language and environment for statistical computing , 2010 .

[17]  Kenneth A Ellenbogen,et al.  2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (Updating the 2006 Guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. , 2011, Journal of the American College of Cardiology.

[18]  Anonymous,et al.  Full report , 2019 .

[19]  Hadley Wickham,et al.  Spatial Visualization with ggplot2 , 2016 .

[20]  B. Gersh Association Between Timeliness of Reperfusion Therapy and Clinical Outcomes in ST-Elevation Myocardial Infarction , 2011 .

[21]  Richard Beare,et al.  An Introduction to Software Tools, Data, and Services for Geospatial Analysis of Stroke Services , 2019, Front. Neurol..

[22]  Harlan M Krumholz,et al.  Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction. , 2006, Journal of the American College of Cardiology.