Challenges encountered by healthcare workers in managing door-to-balloon time of myocardial infarction: A survey.

BACKGROUND

ST-segment elevation myocardial infarction (STEMI) demands aggressive and rapid medical intervention. Delays in Door-to-balloon time (DTB) of more than 90 min cause progressive damage to the cardiac tissue and require immediate medical intervention, including percutaneous coronary intervention (PCI). Nurses and doctors in STEMI management face several challenges that result in a delay in DTB time.

AIM: To investigate challenges nurses and doctors encounter in managing Door to Balloon (DTB) time for ST-elevation Myocardial Infarction (STEMI) patients.

METHOD: An online survey using Qualtrics software was distributed to all nurses and doctors working in the Emergency Room and Cardiac Catheterization Laboratory at the study site, which included a total of 150 staff members. The survey was conducted in August 2023 and lasted for one month. The questionnaire online link was sent to the participants and filled out by them through their smartphones.

RESULTS

A total of 83 nurses and doctors responded to the questionnaire. The survey revealed several challenges encountered by nurses and doctors in STEMI management from highest to lowest based on response items in the Likert scale. In ER, the reported challenges related to the ECG interpretation (mean = 33, 47.8 %), followed by Process (mean = 31.5, 45.6 %), Resources (mean = 30.0, 43.5 %), Communication (mean = 28.8, 41.7 %), and Healthcare setting (28, 40.6 %). In CCL, the most reported challenges were related to Communication (mean = 10, 71.4 %). Followed by Resources (mean = 7.5, 53.5 %), and Healthcare setting (mean = 28, 40.6 %). The primary outcomes showed no statistically significant association of predictable variables of Age groups with a p value of 0.612 (21-30 years, mean 3.31 ± 0.95, 31-40 years, mean 3.62 ± 1.17, 41-50 years, mean 3.7 ± 1.22), Educational groups with a p value of 0.481(Diploma 3.60 ± 1.23, Bachelor 3.33 ± 0.97, Postgraduate 3.79 ± 1.18), Years of experience groups with a p value of 0.659, two-tailed (10 years of experience 3.65 ± 1.23, and More than 10 years of experience 3.65 ± 1.23), and groups of certified with an ECG interpretation course with a p value of 0.583, two-tailed (Certified with an ECG interpretation course 3.62 ± 1.16 and not Certified with an ECG interpretation course 3.42 ± 1.08) on the Knowledge variable. Similarly, the outcomes showed no statistically significant association of predictable variables of Age with a p value of 0.615 (21-30 years, mean 31.91 ± 5.43, 31-40 years, mean 32.61 ± 6.38, 41-50 years, mean 30.31 ± 8.08) Educational groups with a p value of 0.325(Diploma 29.87 ± 7.75, Bachelor 31.93 ± 5.95, Postgraduate 33.41 ± 6.02), Years of experience groups with a p value of 0.813, two-tailed (10 years of experience 32 ± 6.283, and More than 10 years of experience 31.53 ± 7.27), certified with an ECG interpretation course with a p value of 0.197, two-tailed (Certified with an ECG interpretation course 31.17 ± 6.83 and not Certified with an ECG interpretation course 33.91 ± 5.67) on the GSE variable.

CONCLUSION

The study reveals challenges encountered the nurses and doctors in ER & CCL in managing DTB time for STEMI patients were related to factors like skills in ECG interpretation, the STEMI management process, equipment unavailability, and team communication. This study concluded that factors like age, education, years of experience, and ECG certification were not associated with the participants' knowledge and GSE.