Are there any differences in prehospital ACS care within one city? Comparison of prehospital care provided by emergency physicians from two tertiary care hospitals. Further evaluations of the “MONAH-1” study

Background Acute coronary syndrome (ACS) is a time-critical medical emergency in which early guideline-based prehospital diagnosis and treatment are crucial for the further course of treatment. The aim of this study was to compare the quality of prehospital care provided by emergency physicians at two maximum care hospitals in Magdeburg. Methods As part of the retrospective, bicentric observational study MONAH-1, all prehospital physician missions with typical ACS diagnoses in Magdeburg between 2014 and 2018 were analysed. Using defined quality indicators in accordance with ESC guidelines (including 12-lead ECG, administration of acetylsalicylic acid (ASA), heparin, morphine, oxygen and nitro-glycerine), a comparison was made between emergency physicians at the University Medical Centre (MD1) and Magdeburg Hospital (MD2). The statistical analysis included univariate and multivariate logistic regression analyses adjusted for age and gender. Results A total of 1,438 emergency physician interventions were evaluated (MD1: n = 661; MD2: n = 777). Emergency physicians at MD1 performed 12-lead ECGs significantly more often (76.9% vs. 43.5%; aOR 4.24 [95% CI 3.36–5.35]), administered ASA more often (91.4% vs. 70.9%; aOR 4.38 [3.19–6.00]) and heparin (92.6% vs. 68.0%; aOR 5.86 [4.21–8.16]) more frequently, and administered morphine for pain intensity VAS ≥ 4 (70.6% vs. 54.5%; aOR 2.67 [2.04–3.50]; p < 0.001 in each case). No significant differences were found for the indication-appropriate administration of nitro-glycerine and oxygen. The prehospital dwell time was longer in MD1 (median 34 vs. 29 minutes; p < 0.001). Conclusion Prehospital care for ACS patients differed between the two emergency medical service locations. Emergency physicians at MD1 implemented guideline-recommended diagnostic and therapeutic measures more frequently, possibly facilitated by a longer prehospital dwell time and location-specific organisational structures. The results underscore the influence of organisational conditions on the quality of prehospital care and provide starting points for future quality assurance measures.