CORRELATION OF WAITING TIME WITH ADVERSE EVENTS IN PATIENTS ADMITTED FOR NONELECTIVE PERMANENT PACEMAKER IMPLANTATION

OBJECTIVE: To determine the effect of a dedicated permanent pacemaker implantation procedure room on waiting time and waiting time-related m orbidity. DESIGN: Retrospective chart review. SETTING: Two tertiary ca re teaching hospitals in southern Ontario; one with a dedicated proced ure room (centre B) and one without (centre A). PATIENTS: Two hundred and fourteen consecutive patients who required permanent pacing urgent ly or emergently. METHODS: Charts were examined retrospectively at cen tre A (131 patients) and centre B (83 patients) to determine the waiti ng rime for and the number of preoperative adverse events in nonelecti ve permanent pacemaker implantation. RESULTS: Patients in centre A wai ted a mean of 4.5+/-3.0 days while patients in centre B waited a mean of 1.9+/-1.6 days (P=0.0001). Centre A patients experienced a total of 57 adverse events that were likely or possibly related to the waiting period, while patients at centre B experienced eight such events (P<0 .0001). Thirty-three per cent of the centre A patients experienced at least one adverse event, while 8% of centre B patients experienced at least one adverse event (P<0.00001). Of the centre A patients who wait ed for more than six days (26 patients), 58% had at least one adverse event, compared with 26% of those who waited less than six days (105 p atients, P=0.0009). CONCLUSIONS: Delays in implanting nonelective perm anent pacemakers are strongly associated with an increase in adverse e vents. Measures to shorten the waiting time are likely to result in a reduction in morbidity in conjunction with a beneficial impact on heal th care resource utilization.