Influence of Organisational-Level Factors on Delayed Door-to-Balloon Time among Patients with ST-Elevation Myocardial Infarction

Abstract

Objective: To estimate the door-to-balloon (DTB) time and determine the organisational-level factors that influence delayed DTB times among patients with ST-elevation myocardial infarction in the Sultanate of Oman. Methods: A cross-sectional retrospective study was conducted. All patients who presented to the emergency department at two public hospitals and underwent primary percutaneous interventions during the period of two years were included. Results: The sample included 426 patients. The median door-to-balloon time was 142 minutes. The result of bivariate logistic regression showed that patients who presented to the emergency department with atypical symptoms were three times more likely to have a delayed DTB time compared with patients presenting with typical symptoms (OR = 3.003, 95% CI: 1.409–6.400, p = .004). In addition, patients who presented during off-hours were two times more likely to have a delayed DTB time compared with patients who presented during regular working hours (OR = 2.291, 95% CI: 1.284–4.087, p = .005). Conclusion: To meet the door-to-balloon time recommendation, it is important to ensure that there is adequate staffing during both regular and irregular working hours. Results from this study can be used as a baseline for future studies and inform strategies for improving the quality of care.

Keywords: Acute Myocardial Infarction; Clinical Management; Door-to-balloon Time; Emergency Care Systems; Staffing and Scheduling; Oman.