Care Delays in Patients with Signs and Symptoms of Acute Myocardial Infarction: A Quantitative Research Critique

This article is a critique of a quantitative research article on care delays in patients with signs and symptoms of acute myocardial infarction. The critique examines the relevance and urgency of the matter, the methodology used, and the credibility of the author. The article is robust and credible, with a comprehensive presentation of the research methodology.

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Introduction
The article selected for the critical review is a quantitative article by Sanders (2017), which is
entitled “Care delays in patients with signs and symptoms of acute myocardial infarction
(AMI)”. I have chosen this article because of the relevance and urgency of the matter its
addressing. Recent statistics indicate that acute myocardial infarction which is one of the
major cardiovascular diseases (CVD) is the leading cause of mortality and morbidity across
the world and accounts for about 35% of overall deaths worldwide. According to the World
Health Organization (WHO), approximately 12 million people succumb to CVD each year,
and this number is likely to increase to 25 million deaths annually by 2020 (Kazemi et al.,
2009). Additionally, the studies conducted by Terkelsen et al. (2011) on CVD such as acute
myocardial infarction show that lack of prompt treatment of the disorder might lead to
complications including disability and even death. Thus, there is a need to further examine
the care delays in patients with acute myocardial infarction to increase the quality of life and
reduce the resulting cost to the healthcare system due to the delay.
Hoe and Hoare (2012) observes that research critiquing is significant because it exposes the
strengths and weaknesses of a study and thus provides recommendations on its improvements
based on the observed weaknesses. This increases the credibility of research making it more
reliable and relevant to the area of study (Hoe and Hoare, 2012). As a result, this critique
paper will utilise Caldwell et al. (2005) critiquing tool to critique the research but with a
particular selection of the relevant steps. According to Polit and Beck (2010) evidence-Based
practice is significant because it is based on real-time events or subjects thus it can reliably be
applied to different contexts with relatively similar settings thus increasing its
generalizability. The study by Sanders (2017) is a retrospective correlational study that
analyses data from patients with symptoms of myocardial infarction to ascertain any delays in
their treatment.

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Critique
The Caldwell et al. (2005) critical tool will be used to review the study by Sanders (2017)
critically. The specific elements of the tool that will be used include the title, credibility of the
authors, clarity of the rationale, abstract, literature review, study aims, ethical considerations,
and methodology of the study. The findings and conclusions will also be critiqued. The title
of the research reflects the content because it indicates the characteristics of the subjects
under investigation “patients with signs and symptoms of acute myocardial infarction”, and
the objective which is to examine the care delays that they experience. According to Caldwell
et al. (2005), these features indicate that the title is a reflection of the content. However, the
title doesn’t expressly show the place where the study was to be conducted.
The author of the study is credible. She is an assistant professor in nursing at Georgia
Southern University. Furthermore, the article has been peer-reviewed by external
professionals and accepted for publication, an indication that it was done professionally. The
abstract succinctly summarises the main areas of the study namely the aim, methods, results,
and conclusion. Each section has been summarised in a way that makes sense and provides a
hint to the issues addressed in each part of the study. According to Caldwell et al. (2005)
critiquing framework, these features make the study credible.
The researcher has presented the rationale of the study in the background section. Several
references have been made to justify the rationale. Gilboy et al. (2012) observe that patients
diagnosed with AMI symptoms should be triaged within ten minutes and labelled as an
emergency case. Although there is not an internationally accepted triage assessment period, it
is expected that the process is carried out promptly. Studies have also indicated that an
association exists between timely intervention and better results (Atzema et al. 2011).
However, delays in emergency care are still evident among AMI patients. Research has been
carried out on triage delays (Weber, McAlpine, and Grimes, 2011) in acquiring ECGs

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(Atzema et al., 2009) but still the cause for these delays is yet to be studied. Dallaire et al.
(2012) also assessed the experience of nurses and the precision of decisions based upon
triage. However, no specific research has been conducted to evaluate the experience of nurses
in the triage delays and in obtaining ECGs for patients diagnosed with AMI symptoms and
signs.
The literature review is equally clear and up-to-date and covers a wide range of literature
relevant to the topic under study. The author first provides the prevalence of the disease and
the existing medication approaches. Then using previous studies, the author shows the
significance of prompt care to patients with AMI symptoms. Earlier studies on various
aspects of the research have also been examined to provide in-depth background information
on the area of study. Moreover, the author cites the most current references not older than ten
years as at and when the study was conducted (Sanders, 2017). Thus, through the literature
review, the author has disclosed the existing research gap and the importance of filling it.
The aim of the study has clearly been stated and described. Besides the author indicating the
importance of the study by demonstrating the existence of a research gap, she has described
the aim of the research and then explicitly stated it, which is “to explore the factors related to
time to triage and time to ECG in patients with signs and symptoms of AMI” (Sanders,
2017). The critique framework by Caldwell et al. (2005) reports a clear description of the
study aim to consist of identifying a research gap.
The study adequately considered all ethical issues associated with the study. The study
obtained ethical approval from the university’s institutional review board. The study also
ensured that the privacy and confidentiality of the participant patients were protected. The
electronic data file which was used in the analysis did not have any identification of the
nurses or patients, and it was stored in a computer with limited access and password-

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protected. The consent of the participants was not required since the personal information
was excluded from the retrieved database. Fouka and Mantzorou (2011) cites ethical
considerations to include ethical approval, informed consent among others.
Furthermore, informed consent of the nurses was obtained during the survey with regard to
their profiles. According to Cacciattolo (2015) ethical considerations in research, help to
effectively achieve the aim of the study by ensuring that there is no misrepresentation of facts
and thus minimise bias. Furthermore, ethical considerations, especially in clinical research,
improve the credibility of the findings because it shows that the researchers were accountable
and therefore their inferences can be trusted (Cacciattolo, 2015).
The methodology of the study has been identified but not justified. For instance, the research
indicates that it is a retrospective correlational study, the procedures followed in collecting
data, analysis and presentation have also been presented. Mackey and Gass (2015) observe
that a clear research methodology is critical because it enables replication thus increasing its
credibility. Furthermore, an in-depth research methodology that has been explained in a study
makes it easy for readers to notice any possible error or bias that might affect the quality of
the study (Mackey and Gass, 2015). The inclusion and exclusion criteria have also been
adequately described. This minimises the possibility of selection bias and improves the
validity of the findings (Pannucci and Wilkins, 2010). However, the author doesn’t justify the
methodology, thus leaving room for doubt as to whether the approach was appropriate in
achieving the aim of the study (Mackey and Gass, 2015).
The author has identified the study design as a retrospective correlational design but no
evidence of justification for the selection whatsoever. This compromises the quality of the
study. Creswell and Creswell (2017) reported that the most appropriated research design
should be selected, one that will ensure that the objectives of the study are achieved. The lack

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of justification for the use of a retrospective correlational design affects the quality of the
study because it cannot be ascertained at a glance whether it was the best choice for the study.
The study did not state any hypothesis. However, it can be inferred from both the aim and
rationale of the study. Barr et al. (2013) note that a study hypothesis ensures that the whole
process of research remains scientific and reliable. Farrugia et al. (2010) elucidates that lack
of hypothesis in the study increases the risk of deviating from the aim of the study and
therefore compromising its reliability.
The study has identified and described critical variables in the research. The dependent
variables included the time taken from checking in to ED triage and to retrieve an ECG,
whereas the independent variables comprised of the demographic profiles of the participants
(Sanders, 2017). Garson (2012) expounds that variables are critical in quantitative research
because they help to measure concepts in the analysis. The identification of variables in the
study will, therefore, help in ascertaining the relationship between timely interventions and
improved results in the treatment of AMI symptoms.
The study population has also been identified and described as 286 patients with AMI signs
and symptoms in addition to emergency department nurses. The disclosure and description of
the study population are necessary because it shows whether the evidence-based study was
based on the relevant population. This affects the validity and reliability of the findings and
inferences (Drost, 2011). Additionally, Polit and Beck (2010) posit that a description of the
study population in quantitative research strengthens generalizability because similar
methodology can be replicated in the setting with relatively identical population features.
The author has also described the sample of the study by proving a detailed description of the
inclusion and exclusion criteria and the number that met the inclusion criteria to be 286 out of
559 records that were searched. Mugenda and Mugenda (2012) opine that a sample size of

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10% of the population is an adequate representation. The sample size is over 50% of the
study population thus it adequately represented the population.
The method of data collection was through electronic search. This approach is valid and
reliable because it allows the researcher to restrict the search to the inclusion criteria (Chow,
2015). Descriptive and inferential statistics were used to analyse data using Predictive
Analytics Software (PAWS). Descriptive and inferential statistics are analytical and standard
procedures that help to present findings accurately. Descriptive statistics present data in a
visualised way which enables more straightforward interpretation, whereas the inferential
displays the correlation between the study variables (Van Elst, 2013). Thus, the methods of
analysis are valid and reliable (Mertler and Reinhart, 2016).
The findings have been presented under sub-themes that have been derived for the aim of the
study such as triage delay and ECG delay. Additionally, the results have been presented in
table formats thus making it visually appealing and easy to interpret (Anderson, 2010). The
results can be generalizable because the sample population upon which they are based are
representative of the population and been adequately described. Furthermore, the
characteristics of both the study population and the sample have adequately been described
(Polit and Beck, 2010). The results have also been shown to agree with the previous studies
thus increasing its external validity of generalisation (Øvretveit et al., 2011).
The conclusion is comprehensive enough because it identifies the significant findings and the
factors that cause the same. Additionally, the conclusion reports the contribution of the study
and recommendations for future studies (Labaree, 2013). The findings of the study have
implications for clinical practice. Healthcare providers can understand the factors that are
associated with the delay between arrival and triage and obtaining ECG in patients with AMI

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signs and symptoms (Sanders, 2017). This will significantly affect the quality of healthcare
services and reduce the morbidity and mortality caused by the delays.
Conclusion
Care delays in patients presented with AMI symptoms are still evident with most of the
delays being observed from the time the patient checks in to triage and in obtaining ECG.
This delay is attributed to the increasing incidences of morbidity and mortality of AMI
patients. This critical review emphasises on the need for additional studies into the specific
processes that cause the delay. The methodology used in the critiqued article was most
appropriate for the study because of the different procedures and protocols used were
presented and replicable. However, the study was only based on two emergency departments
in the United States. This limits the replication of the study to middle and low-level countries
which are also affected by AMI.
Nonetheless, the article is robust and credible for several reasons. First, the author is qualified
and an expert in the field, secondly, it is an evidence-based research meaning that the
inferences and conclusions have been based on actual life experiences. Third, the sample size
is adequately representative of the whole population, and lastly, the research methodology
has comprehensively been presented.

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