Article Data

  • Views 1831
  • Dowloads 158

Original Research

Open Access

Effect of the hospital transfer of STEMI patients through the remote emergency consultation system on the emergency department length of stay and survival at hospital discharge: a single center retrospective cohort study

  • Heejun Shin1
  • Jae Hyuk Kim2,*,
  • Jong Kab Noh2
  • Jaehyun Lee2

1Department of Emergency Medicine, Soonchunhyang University Hospital, 14584 Bucheon, Republic of Korea

2Department of Emergency Medicine, Mokpo Hankook Hospital, National Emergency Medical Center, National Medical Center, 58643 Seoul, Republic of Korea

DOI: 10.22514/sv.2023.012 Vol.19,Issue 4,July 2023 pp.79-90

Submitted: 12 July 2022 Accepted: 30 August 2022

Published: 08 July 2023

*Corresponding Author(s): Jae Hyuk Kim E-mail:


This study aimed to analyze and determine the effects of emergency department (ED) length of stay (LOS) and survival at hospital discharge (SHD) on patients with ST-segment elevation myocardial infarction (STEMI) treated by the Remote Emergency Consultation System (RECS), a government-led teleconsultation project. This was a retrospective cohort chart review performed at a single center. The study period was from 01 May 2015, to 31 December 2020. The RECS group was set as the intervention group among the total transferred STEMI patients, and the No-RECS group was set as the control group. Ninety-eight patients with STEMI were collectively included in the No-RECS (n = 56) and RECS (n = 42) groups. The median value of ED LOS was 31 (21, 46.5) min in the No-RECS group and 21.5 (13.25, 37.25) min in the RECS group (p = 0.0329). The variables (odds ratio (95% confidence interval (CI)); p-value) predictive of SHD in the patients with STEMI were systolic blood pressure (SBP) (1.09 (1.003, 1.19); p = 0.0413) and total hospital days (2.95 (1.05, 8.26); p = 0.0399). The optimal cut-off points (sensitivity and specificity) of the receiver operating characteristic (ROC) curve of the SBP and total hospital days to predict SHD in the patients with STEMI were (0.742, 1) 105 and (0.753, 1) 3.5, respectively. RECS was associated with a decrease in EDLOS in patients with STEMI, but showed no association with SHD. SBP at the time of the ED visit and total hospital days were positively correlated with SHD.


Telemedicine; STEMI; Length of Stay; Survival

Cite and Share

Heejun Shin,Jae Hyuk Kim,Jong Kab Noh,Jaehyun Lee. Effect of the hospital transfer of STEMI patients through the remote emergency consultation system on the emergency department length of stay and survival at hospital discharge: a single center retrospective cohort study. Signa Vitae. 2023. 19(4);79-90.


[1] Vaughan L, Edwards N. The problems of smaller, rural and remote hospitals: separating facts from fiction. Future Healthcare Journal. 2020; 7: 38–45.

[2] Alrawashdeh A, Nehme Z, Williams B, Smith K, Brennan A, Dinh DT, et al. Impact of emergency medical service delays on time to reperfusion and mortality in STEMI. Open Heart. 2021; 8: e001654.

[3] Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal. 2018; 39: 119–177.

[4] O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Circulation. 2013; 127: e362–e425.

[5] Papai G, Csato G, Racz I, Szabo G, Barany T, Racz A, et al. The transtelephonic electrocardiogram-based triage is an independent predictor of decreased hospital mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Journal of Telemedicine and Telecare. 2020; 26: 216–222.

[6] Lambert L, Brown K, Segal E, Brophy J, Rodes-Cabau J, Bogaty P. Association between timeliness of reperfusion therapy and clinical outcomes in ST-elevation myocardial infarction. JAMA. 2010; 303: 2148–2155.

[7] Terkelsen CJ, Sørensen JT, Maeng M, Jensen LO, Tilsted HH, Trautner S, et al. System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention. JAMA. 2010; 304: 763–771.

[8] Rasmussen MB, Frost L, Stengaard C, Brorholt-Petersen JU, Dodt KK, Søndergaard HM, Terkelsen CJ. Diagnostic performance and system delay using telemedicine for prehospital diagnosis in triaging and treatment of STEMI. Heart. 2014; 100: 711–715.

[9] Brunetti ND, De Gennaro L, Correale M, Santoro F, Caldarola P, Gaglione A, et al. Pre-hospital electrocardiogram triage with telemedicine near halves time to treatment in STEMI: a meta-analysis and meta-regression analysis of non-randomized studies. International Journal of Cardiology. 2017; 232: 5–11.

[10] Mehta S, Botelho R, Cade J, Perin M, Bojanini F, Coral J, et al. Global challenges and solutions. Interventional Cardiology Clinics. 2016; 5: 569–581.

[11] Lee W, Byun IS. Study on emergency medical care teleconsultation network in vulnerable areas. Korean Journal of Health Economics and Policy. 2019; 25: 49–71.

[12] RECS Homepage in National Emergence Medical Center and Ministry of Health and Welfare. 2022. Available at: (Accessed: 16 February 2022).

[13] Business constructing EMS remote-cooperative medical treatment network including Remote Emergency Consultation System (RECS) in National Emergency Medical Center (NEMC). 2022. Available at: (Accessed: 16 February 2022).

[14] News of the nationwide expansion of the RECS on July 2016 in Ministry and Health and Welfare. 2016. Available at: MENU_ID=04&MENU_ID=0403&page=319&CONT_SEQ=333176 (Accessed: 16 February 2022).

[15] Population of the Jeollanam-do District in 2018. 2018. Available at: english0106020000 (Accessed: 16 February 2022).

[16] Google Map. 2022. Available at:,126.8850014,9.62z?hl=en (Accessed: 16 February 2022).

[17] Naver map direction service. 2022. Available at: https://map.naver. com/v5/directions/-/-/-/transit?c=14116716.7187069, 4482400.6810241,15,0,0,0,dh (Accessed: 16 February 2022).

[18] Fluss R, Faraggi D, Reiser B. Estimation of the youden index and its associated cutoff point. Biometrical Journal. 2005; 47: 458–472.

[19] Eleid MF, Zheng PP, Gulati R, Bergman P, Kottenstette N, Li Y, et al. Remote robotic percutaneous coronary intervention: an animal feasibility study. Catheterization and Cardiovascular Interventions. 2021; 97: E274–E279.

[20] Shin DH, Kang HJ, Jang JS, Moon KW, Song YB, Park DW, et al. The current status of percutaneous coronary intervention in Korea: based on year 2014 & 2016 cohort of Korean percutaneous coronary intervention (K-PCI) registry. Korean Circulation Journal. 2019; 49: 1136–1151.

[21] Szabó GT, Ágoston A, Csató G, Rácz I, Bárány T, Uzonyi G, et al. Predictors of hospital mortality in patients with acute coronary syndrome complicated by cardiogenic shock. Sensors. 2021; 21: 969.

[22] Gibson CM, Mehta S, Ceschim MRS, Frauenfelder A, Vieira D, Botelho R, et al. Evolution of single-lead ECG for STEMI detection using a deep learning approach. International Journal of Cardiology. 2022; 346: 47–52.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time