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 language | English (US) |
|---|---|
| Pages (from-to) | 73-92 |
| Number of pages | 20 |
| Journal | Point of Care |
| Volume | 17 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 1 2018 |
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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 journal › Article
}
TY - JOUR
T1 - Point-of-Care Diagnosis of Acute Myocardial Infarction in Central Vietnam
T2 - International Exchange, Needs Assessment, and Spatial Care Paths
AU - Kost, Gerald J
AU - Zadran, Amanullah
AU - Duong, Thuan T.B.
AU - Pham, Tung T.
AU - Ho, An V.D.
AU - Nguyen, Nhan V.
AU - Ventura, Irene J.
AU - Zadran, Layma
AU - Sayenko, Mykhaylo V.
AU - Nguyen, Kelly
PY - 2018/9/1
Y1 - 2018/9/1
N2 - 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.
AB - 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.
KW - Acute coronary syndrome (ACS)
KW - ambulance
KW - cardiac troponin (cTn) I and T
KW - district hospitals
KW - evidence-based medicine (EBM)
KW - geographic information systems
KW - hospital levels
KW - Hue University of Medicine and Pharmacy (HUMP)
KW - needs assessment
KW - point-of-care (POC) culture
KW - prehospital diagnosis
KW - primary care
KW - small-world networks (SWNs)
KW - Thua Thien Hue Province (TTHP)
KW - value proposition
UR - http://www.scopus.com/inward/record.url?scp=85052682486&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85052682486&partnerID=8YFLogxK
U2 - 10.1097/POC.0000000000000167
DO - 10.1097/POC.0000000000000167
M3 - Article
AN - SCOPUS:85052682486
VL - 17
SP - 73
EP - 92
JO - Point of Care
JF - Point of Care
SN - 1533-029X
IS - 3
ER -