Sample Literature Review Research on Improving Door-to-balloon Time

The study ‘Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients’ is written by Christopher J. Coyne, Nicholas Testa, Shoma Desai, Joy Lagrone, Roger Chang, Ling Zheng, and Hyung Kim. This study sought to investigate whether there would be an efficient diagnosis of STEMI in patients presenting with acute chest pain.  Interventions such as cardiac triage and electrocardiographic imaging in the emergency department (ED) were enacted. The research utilized an interventional study design, whereby the assessment nurse obtained a brief history and appropriate laboratory and basic diagnostic studies, such as ECG, in all patients presenting with acute chest pain at the public teaching hospital (Coyne et al., 2015). The detection of ST-segment elevation myocardial infarction (STEMI) through ECG interpretation prompted the immediate intervention by the cardiology team and the catheterization laboratory. Those patients whose ECG interpretation did not reveal STEMI changes were referred back to the triage section to await further assessment.

The findings of the study indicated that through performing early cardiac triage and decreasing the time taken to obtain electrocardiographic imaging, the mortality of patients presenting with STEMI significantly reduced. Further, the cardiology team was notified in advance to perform catheterization and ballooning for the coronary vessel occlusion (Coyne et al., 2015). This study is relevant to the research question since it is a recommendation of the American Heart Association/American College of Cardiology guidelines to institute rapid door-to-electrocardiography (ECG) times for patients with (STEMI) in an attempt to mitigate the potential acute and chronic consequences of acute coronary syndrome. By effecting such changes in the initial triage, the detection of STEMI will be more efficient in the hospital setting in an attempt to provide better care to patients.

Article 2

The research ‘Nurse-led Early Triage (NET) study of patients presenting with acute chest pain: A long-term evaluation study aimed at improving the management of patients with non-ST-elevation acute coronary syndromes’ was conducted by O’Neill, Smith, Currie, Elder, Wei, and Lang. The primary objective of the research was to evaluate whether early triage and evaluation in the coronary care unit can advance the assessment and the management of patients with a diagnosis of acute coronary syndrome (O’Neill et al., 2014). The population for the study included 274 adult patients of all ages sampled via convenience sampling and who were admitted to the hospital as emergency referrals with complaints of acute chest pain (O’Neill et al., 2014). Both clinical and demographic data from all the participants were recorded. Upon interpretation of the ECG findings, the nurses instituted prompt, evidence-based treatment.

The results of the study were analyzed and interpreted through data analysis techniques, such as the Chi-squared test and the Statistical Package for the Social Sciences (SPSS). The study revealed that; the early triage by nurses significantly reduced the time to ECG recording for patients presenting with acute chest pain. Also, there was a noteworthy increase in the prescription of clopidogrel in patients with acute coronary syndrome and the provision of prompt and quality care in high-risk patients (O’Neill et al., 2014). Remarkably, the benefits realized from this initiation of early triage by nurses were sustained five years later. This study is relevant in answering the research question since it provides substantial evidence on how early assessment and triage by nurses can improve the provision of quality care as recommended by the European Society of Cardiology.




Coyne, C. J., Testa, N., Desai, S., Lagrone, J., Chang, R., Zheng, L., & Kim, H. (2015). Improving door-to-balloon time by decreasing door-to-ECG time for walk-in STEMI patients. Western Journal of Emergency Medicine, 16(1), 184.

O’Neill, L., Smith, K., Currie, P. F., Elder, D. H. J., Wei, L., & Lang, C. C. (2014). Nurse-led Early Triage (NET) study of chest pain patients: a long-term evaluation study of a service development aimed at improving the management of patients with non-ST-elevation acute coronary syndromes. European journal of cardiovascular nursing, 13(3), 253-260.