Evaluation of Cardiology Consultation Quality and Quantity Requested from Emergency Departments in Turkey
Abstract
Introduction: Emergency cardiac consultation is a very big part of cardiology practice and there is not any trial evaluating this subject qualitatively and quantitatively with different perspectives yet. We wanted to investigate this process in terms of correlation between emergency physicians and cardiologists.
Methods: Patients who are consulted in a cross-sectional and prospectively 5 different public hospitals were included in the study. In order to examine the nature and intensity of the cardiology consultations and also the diagnostic compatibility, electrocardiography (ECG) and to investigate the adequacy of the first medical treatment were chi-square and correlation analyzes. A P value <0.05 was accepted as a statistical significance limit.
Results: Totally 627 patients (502 patients by practitioners and 125 patients by emergency medicine specialists) were consulted to cardiology. The most common admission cause was chest pain (%47.8), and the most common cause of consultation was having no/weak idea about patient’s clinical diagnosis (%39.9). The diagnosis consistency of 48% of consulted patients by EMS was excellent while it was 32.1% in practitioners (p=0.001). Good and excellent ECG interpretation of EMS was 72.8% and it was 50.7% in practitioners (p<0.001). Good and excellent first medical treatment were 46.4% in EMS while it was 38,4 in practitioners (p=0.05). Nearly half of consultations (48.8%) were considered as definitely unnecessary or unnecessary by cardiologists. There was statistically significant correlation between the necessity of consultation and last decision (r=0.811, p<0.001).
Conclusion: There is a big variability in emergency cardiac consultations from the standpoint of consultation necessity, ECG interpretation, first medical management quality and accurate diagnosis.
References
- 1. Segen J. Concise Dictionary of Modern Medicine. 2006;doi:1850703213.
- 2. Kessler C, Kutka BM, Badillo C. Consultation in the emergency department: A qualitative analysis and review. Journal of Emergency Medicine. 2012;42(6):704-711.
- 3. Corey, ET; Coplan, MJ; Spencer K, et al. Cardiology Consultation in the Emergency Department Reduces Re-hospitalizations for Low-Socioeconomic Patients with Acute Decompensated Heart Failure. Am J Med. 2017;130(9)(1112):17-31.
- 4. Ozcete E, Kacmaz O, Damar O, Ustundag M, Orak M, Guloglu C. Evaluation of Consultations Requested from Patients Admitted to the Emergency Department. Eurasian Journal of Emergency Medicine. 2015;14(3):113-117.
- 5. Eken O, Goksu E, Eray O, Yalcinkaya S. The consistency of emergency physicians’ and cardiologists’ ECG interpretation and likelihood classification of chest pain patients. International Journal of Clinical Practice. 2006;60(10):1194-1197.
- 6. Ginde AA, Char DM. Emergency medicine residency training in electrocardiogram interpretation. Academic Emergency Medicine. 2003;10(7):738-742.
- 7. Madsen T, Smyres C, Wood T, et al. Cardiology consultation reduces provocative testing rates in an ED observation unit. American Journal of Emergency Medicine. 2017;35(1):25-28.
- 8. Oktay C, Cete Y, Eray O, Pekdemir M, Gunerli A. Appropriateness of Emergency Department Visits in a Turkish University Hospital. Croatian Medical Journal. 2003;44(5):585-591.
- 9. Foldes SS, Fischer LR, Kaminsky K. What Is an Emergency? The Judgments of Two Physicians. Annals of Emergency Medicine. Published online 1994. doi:10.1016/S0196-0644(94)70322-1.
- 10. LaCoursiere DY, Nager CW. A comparison of two models of gynecology service consultation to the emergency department in an academic medical center. American Journal of Obstetrics and Gynecology. 2003;188(5):1166-1168.
- 11. Vissers MC, Hasman A, Linden CJ. Consultation behaviour of residents supported with a protocol processing system (ProtoVIEW) at the emergency ward. International Journal of Bio-Medical Computing. 1995;38(2):181-187.
Türkiye’de Acil Servisten Yapılan Kardiyoloji Konsültasyonlarının Kalitatif ve Kantitatif Olarak İncelenmesi
Abstract
Giriş: Acil kardiyoloji konsültasyonları kardiyoloji pratiğinin büyük bir kısmını teşkil etmektedir. Bu çalışmada acil hekimleri ile kardiyologlar arasındaki uyum ve konsültasyonların özellikleri kalitatif ve kantitatif açıdan araştırılmıştır.
Yöntemler: Kesitsel ve prospektif olarak 5 farklı devlet hastanesinde kardiyolojiye acil servisten konsülte edilen hastalar çalışmaya dahil edildi. Kardiyoloji konsültasyonlarının niteliğini ve yoğunluğunu incelemek ve aynı zamanda tanı uyumluluğu, elektrokardiyografi (EKG) yorumlama ve ilk tıbbi tedavinin yeterliliğini araştırmak amacıyla ki-kare ve korelasyon analizleri yapıldı. İstatistiksel anlamlılık sınırı olarak bir p değeri <0,05 kabul edildi.
Bulgular: Toplam 627 hasta (pratisyenler tarafından 502 hasta ve acil tıp uzmanları tarafından 125 hasta) acil servisten kardiyolojiye danışıldı. Kardiyolojiye danışılan hastalarda acile en sık başvuru şekli göğüs ağrısı (%47,8) iken en sık konsültasyon konsülte eden hekimin hastanın tanısı hakkında kesin bir kanaate sahip olmaması nedeniyle yapılmıştı (%39,9). Acil tıp uzmanları (ATU) tarafından danışılan hastalarda kardiyologlarla tanı uyumluluğu %48 iken bu oran pratisyen hekimlerde %32,1 olarak bulundu (p=0,001). Yeterli ve mükemmel EKG yorumlama ATU’da %72,8 iken pratisyen hekimlerde %50,7 olarak bulundu (p<0,001). İlk medikal müdahalede ATU %46,4 oranında yeterli ve mükemmel olarak değerlendirilirken pratisyen hekimlerin %38,4’ü yeterli ve mükemmel bulundu (p=0,05). Konsültasyonların yarısına yakını (%48,8) kardiyologlar tarafından gereksiz veya çok gereksiz olarak değerlendirildi. Konsültasyon gerekliliği ile hasta hakkında verilen son karar arasında istatistiksel olarak anlamlı bir ilişki bulundu (r=0,811, p<0,001).
Sonuç: Konsültasyon gerekliliği, EKG yorumlama, ilk tıbbi müdahale ve doğru tanı koyma bakımından acil kardiyoloji konsültasyonlarında ciddi farklılıklar tespit edildi.
Keywords
References
- 1. Segen J. Concise Dictionary of Modern Medicine. 2006;doi:1850703213.
- 2. Kessler C, Kutka BM, Badillo C. Consultation in the emergency department: A qualitative analysis and review. Journal of Emergency Medicine. 2012;42(6):704-711.
- 3. Corey, ET; Coplan, MJ; Spencer K, et al. Cardiology Consultation in the Emergency Department Reduces Re-hospitalizations for Low-Socioeconomic Patients with Acute Decompensated Heart Failure. Am J Med. 2017;130(9)(1112):17-31.
- 4. Ozcete E, Kacmaz O, Damar O, Ustundag M, Orak M, Guloglu C. Evaluation of Consultations Requested from Patients Admitted to the Emergency Department. Eurasian Journal of Emergency Medicine. 2015;14(3):113-117.
- 5. Eken O, Goksu E, Eray O, Yalcinkaya S. The consistency of emergency physicians’ and cardiologists’ ECG interpretation and likelihood classification of chest pain patients. International Journal of Clinical Practice. 2006;60(10):1194-1197.
- 6. Ginde AA, Char DM. Emergency medicine residency training in electrocardiogram interpretation. Academic Emergency Medicine. 2003;10(7):738-742.
- 7. Madsen T, Smyres C, Wood T, et al. Cardiology consultation reduces provocative testing rates in an ED observation unit. American Journal of Emergency Medicine. 2017;35(1):25-28.
- 8. Oktay C, Cete Y, Eray O, Pekdemir M, Gunerli A. Appropriateness of Emergency Department Visits in a Turkish University Hospital. Croatian Medical Journal. 2003;44(5):585-591.
- 9. Foldes SS, Fischer LR, Kaminsky K. What Is an Emergency? The Judgments of Two Physicians. Annals of Emergency Medicine. Published online 1994. doi:10.1016/S0196-0644(94)70322-1.
- 10. LaCoursiere DY, Nager CW. A comparison of two models of gynecology service consultation to the emergency department in an academic medical center. American Journal of Obstetrics and Gynecology. 2003;188(5):1166-1168.
- 11. Vissers MC, Hasman A, Linden CJ. Consultation behaviour of residents supported with a protocol processing system (ProtoVIEW) at the emergency ward. International Journal of Bio-Medical Computing. 1995;38(2):181-187.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | November 30, 2022 |
| Published in Issue | Year 2022 Volume: 3 Issue: 3 |
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