Point-of-Care Diagnosis of Acute Myocardial Infarction in Central Vietnam: International Exchange, Needs Assessment, and Spatial Care Paths

Gerald J Kost, Amanullah Zadran, Thuan T.B. Duong, Tung T. Pham, An V.D. Ho, Nhan V. Nguyen, Irene J. Ventura, Layma Zadran, Mykhaylo V. Sayenko, Kelly Nguyen

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives Objectives were to (a) advance point-of-care (POC) education, international exchange, and culture; (b) report needs assessment survey results from Thua Thien Hue Province, Central Vietnam; (c) determine diagnostic capabilities in regional health care districts of the small-world network of Hue University Medical Center; and (d) recommend Spatial Care Paths that accelerate the care of acute myocardial infarction (AMI) patients. Methods We organized progressively focused, intensive, and interactive lectures, workshops, and investigative teamwork over a 2-year period. We surveyed hospital staff in person to determine the status of diagnostic testing at 15 hospitals in 7 districts. Questions focused on cardiac rapid response, prediabetes/diabetes, infectious diseases, and other serious challenges, including epidemic preparedness. Results Educational exchange revealed a nationwide shortage of POC coordinators. Throughout the province, ambulances transfer patients primarily between hospitals, rarely picking up from homes. No helicopter rescue was available. Ambulance travel times from distant sites to referral hospitals were excessive, longer in costal and mountainous areas. Most hospitals (92.3%) used electrocardiogram and creatine phosphokinase-MB isoenzyme to diagnose AMI. Cardiac troponin I/T testing was performed only at large referral hospitals. Conclusions Central Vietnam must improve rapid diagnosis and treatment of AMI patients. Early upstream POC cardiac troponin testing on Spatial Care Paths will expedite transfers directly to hospitals capable of intervening, improving outcomes following coronary occlusion. Point-of-care coordinator certification and financial support will enhance standards of care cost-effectively. Training young physicians pivots on high-value evidence-based learning when POC cardiac troponin T/cardiac troponin I biomarkers are in place for rapid decision making, especially in emergency rooms.

Original languageEnglish (US)
Pages (from-to)73-92
Number of pages20
JournalPoint of Care
Volume17
Issue number3
DOIs
StatePublished - Sep 1 2018

Fingerprint

Point-of-Care Systems
Needs Assessment
Vietnam
Myocardial Infarction
Troponin T
Troponin I
Ambulances
Referral and Consultation
Education
Prediabetic State
Financial Support
Patient Transfer
Troponin
Aircraft
Coronary Occlusion
Certification
Standard of Care
Creatine Kinase
Isoenzymes
Communicable Diseases

Keywords

  • Acute coronary syndrome (ACS)
  • ambulance
  • cardiac troponin (cTn) I and T
  • district hospitals
  • evidence-based medicine (EBM)
  • geographic information systems
  • hospital levels
  • Hue University of Medicine and Pharmacy (HUMP)
  • needs assessment
  • point-of-care (POC) culture
  • prehospital diagnosis
  • primary care
  • small-world networks (SWNs)
  • Thua Thien Hue Province (TTHP)
  • value proposition

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Point-of-Care Diagnosis of Acute Myocardial Infarction in Central Vietnam : International Exchange, Needs Assessment, and Spatial Care Paths. / Kost, Gerald J; Zadran, Amanullah; Duong, Thuan T.B.; Pham, Tung T.; Ho, An V.D.; Nguyen, Nhan V.; Ventura, Irene J.; Zadran, Layma; Sayenko, Mykhaylo V.; Nguyen, Kelly.

In: Point of Care, Vol. 17, No. 3, 01.09.2018, p. 73-92.

Research output: Contribution to journalArticle

Kost, GJ, Zadran, A, Duong, TTB, Pham, TT, Ho, AVD, Nguyen, NV, Ventura, IJ, Zadran, L, Sayenko, MV & Nguyen, K 2018, 'Point-of-Care Diagnosis of Acute Myocardial Infarction in Central Vietnam: International Exchange, Needs Assessment, and Spatial Care Paths', Point of Care, vol. 17, no. 3, pp. 73-92. https://doi.org/10.1097/POC.0000000000000167
Kost, Gerald J ; Zadran, Amanullah ; Duong, Thuan T.B. ; Pham, Tung T. ; Ho, An V.D. ; Nguyen, Nhan V. ; Ventura, Irene J. ; Zadran, Layma ; Sayenko, Mykhaylo V. ; Nguyen, Kelly. / Point-of-Care Diagnosis of Acute Myocardial Infarction in Central Vietnam : International Exchange, Needs Assessment, and Spatial Care Paths. In: Point of Care. 2018 ; Vol. 17, No. 3. pp. 73-92.
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abstract = "Objectives Objectives were to (a) advance point-of-care (POC) education, international exchange, and culture; (b) report needs assessment survey results from Thua Thien Hue Province, Central Vietnam; (c) determine diagnostic capabilities in regional health care districts of the small-world network of Hue University Medical Center; and (d) recommend Spatial Care Paths that accelerate the care of acute myocardial infarction (AMI) patients. Methods We organized progressively focused, intensive, and interactive lectures, workshops, and investigative teamwork over a 2-year period. We surveyed hospital staff in person to determine the status of diagnostic testing at 15 hospitals in 7 districts. Questions focused on cardiac rapid response, prediabetes/diabetes, infectious diseases, and other serious challenges, including epidemic preparedness. Results Educational exchange revealed a nationwide shortage of POC coordinators. Throughout the province, ambulances transfer patients primarily between hospitals, rarely picking up from homes. No helicopter rescue was available. Ambulance travel times from distant sites to referral hospitals were excessive, longer in costal and mountainous areas. Most hospitals (92.3{\%}) used electrocardiogram and creatine phosphokinase-MB isoenzyme to diagnose AMI. Cardiac troponin I/T testing was performed only at large referral hospitals. Conclusions Central Vietnam must improve rapid diagnosis and treatment of AMI patients. Early upstream POC cardiac troponin testing on Spatial Care Paths will expedite transfers directly to hospitals capable of intervening, improving outcomes following coronary occlusion. Point-of-care coordinator certification and financial support will enhance standards of care cost-effectively. Training young physicians pivots on high-value evidence-based learning when POC cardiac troponin T/cardiac troponin I biomarkers are in place for rapid decision making, especially in emergency rooms.",
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AU - Pham, Tung T.

AU - Ho, An V.D.

AU - Nguyen, Nhan V.

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KW - prehospital diagnosis

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KW - small-world networks (SWNs)

KW - Thua Thien Hue Province (TTHP)

KW - value proposition

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