None listed
Conditions
Brief summary
Aims: To improve identification and management of patients with ACS within rural hospitals in a Local Health District by implementing a hub and spoke ACS management system. MORACS clinicians will receive notification of patients presenting to intervention Hospitals with ACS symptoms, review ECG, troponin, clinical information and contact the site to provide advice on evidence based treatment. Research Question: In patients admitted to a rural hospital with suspected Acute Coronary Syndrome (ACS), does a centralised management system improve identification of STEMI and subsequent clinical outcomes in all ACS patients?
Interventions
All Rural Emergency Departments within a Local Health District are randomised to either usual care or a mandated transmission of ECG and troponin from spoke (Rural) hospitals to a central hub service. Protocol directed advice from the NSW Health Chest Pain Pathway will be given to the randomised Rural Hospital clinicians by telephone, and will channel patients into the existing ACS management structures: The State Cardiac Reperfusion Strategy (SCRS) for STEMI patients, and the NSW Chest Pain Pat
All Rural Emergency Departments within a Local Health District are randomised to either usual care or a mandated transmission of ECG and troponin from spoke (Rural) hospitals to a central hub service. Protocol directed advice from the NSW Health Chest Pain Pathway will be given to the randomised Rural Hospital clinicians by telephone, and will channel patients into the existing ACS management structures: The State Cardiac Reperfusion Strategy (SCRS) for STEMI patients, and the NSW Chest Pain Pathway for non-STEMI patients. Phone calls to interventional sites will be made within the first 30 minutes of the patients initial arrival to Hospital and as required thereafter during the patients initial presentation to Hospital until the patient is discharged from the Emergency Department or transferred to a Referral centre. Thirty-day and 12-month readmission rates (and reasons) will be identified through the patient information management system, and Centre for Health Record Linkage (CHeReL). Deaths will be identified through the National Death Index. Advice provided will be based on the ECG, Patients troponin, and presentation once established, ensuring consistency with chest pain pathway. Advice will include one of the following dependent on this clinical information; Return to routine care, Conference call to a Cardiologist for advice and potential pt transfer, Advice for admission and transfer to referral Hospital. Clinical data and Advice provided is documented on the research database for analysis at the end of the trial. ECGs will be independently reported and compared with the MORACS service interpretation at the end of the trial. Clinicians providing protocol directed advice and referral will comprise of Senior Cardiology Nursing staff, with extensive experience in ECG interpretation, and management of patients with suspected Acute Coronary Syndrome.
Sponsors
Professor Andrew Boyle
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
30 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All patients presenting with chest pain for investigation to hospitals from rural and remote communities throughout the HNELHD.
Exclusion criteria
Patients with prehospital ECGs performed by ambulance paramedics showing STEMI will NOT go through this process, they will go via existing SCRS pathway. Patients presenting with cardiac arrest who decease prior to ROSC and ECG being performed. Patients receiving active palliation.
Outcome results
None listed