Overcrowding is associated with delays in percutaneous coronary intervention for acute myocardial infarction

Erik B. Kulstad, Ken M. Kelley

Research output: Contribution to journalArticle

34 Scopus citations


Background: Recently developed crowding measures, such as the Emergency Department (ED) Work Index (EDWIN) score, provide a quantifiable measurement of overcrowding in the ED. Aims: We sought to determine the association between overcrowding, measured with the EDWIN score, and the time required to initiate percutaneous coronary intervention (PCI) for patients presenting to the ED with acute myocardial infarction (AMI). Methods: We retrospectively reviewed the performance improvement (PI) data on all patients presenting to the ED over a 2-month period with chest pain and whose subsequent ECG showed AMI requiring PCI. We recorded the time from patient presentation to the (1) time to first ECG, (2) time to patient arrival in the catheterization laboratory, and (3) time to catheter balloon inflation. We calculated EDWIN scores using data archived from our electronic tracking board and compared the proportion of patients who achieved our established ED goal times between patients presenting during low crowding (EDWIN < 1.5) and high crowding (EDWIN≥ 1.5) conditions. Results Seventeen patients underwent emergent PCI in the study period. Patients presenting to the ED during periods of low crowding had shorter times to balloon inflation (median of 84 min, IQR 80 to 93 min) than patients presenting to the ED during periods of high crowding (median of 107 min, IQR 94 to 122 min), P=0.008. Times to first ECG and to arrival in the catheterization laboratory were not significantly different between patients presenting during low and high crowding conditions. Conclusion: Overcrowding appears to be associated with a decreased likelihood of timely treatment for acute AMI in our ED.

Original languageEnglish (US)
Pages (from-to)149-154
Number of pages6
JournalInternational Journal of Emergency Medicine
Issue number3
StatePublished - Sep 1 2009



  • Edwin score
  • Myocardial infarction
  • Overcrowding
  • Treatment delays

ASJC Scopus subject areas

  • Emergency Medicine

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