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Minimizing transfer time to an ST segment elevation myocardial infarction-receiving center: a modified Delphi
Bryn E Mumma1, Conrad Williamson, Rahul K Khare
1From the *Department of Emergency Medicine, University of California Davis, Sacramento, CA; †University of California Davis School of Medicine, Sacramento, CA; ‡Department of Emergency Medicine, Northwestern University, Chicago, IL; and §Department of Emergency Medicine, Kaiser Permanente South Sacramento, Sacramento, CA.
Insights
Transferring ST segment elevation myocardial infarction (STEMI) patients to a STEMI-receiving center is crucial. Prehospital ECGs and established transfer protocols significantly minimize delays in reperfusion therapy.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Systems Research
Background:
- Two-thirds of ST segment elevation myocardial infarction (STEMI) patients arrive at hospitals without percutaneous coronary intervention (PCI) capabilities.
- Transfer to a STEMI-receiving center can delay critical reperfusion therapy, but factors influencing this delay are not well understood.
- Optimizing STEMI care pathways requires identifying system-level practices to reduce inter-facility transfer times.
Purpose of the Study:
- To identify and prioritize system practices that minimize transfer time for STEMI patients to a STEMI-receiving center.
- To achieve expert consensus on critical factors influencing STEMI patient transfer efficiency.
Main Methods:
- A 3-round modified Delphi study involving emergency medical services, emergency medicine, and cardiology experts.
- Candidate system practices were identified through a comprehensive literature review.
- Consensus was defined by 80% agreement on variable importance (mean score ≥ 4.25 or ≤ 1.75).
Main Results:
- Twenty-nine experts participated in round 1, 22 in round 2, and 14 in round 3.
- Eighteen critical system practices were identified to minimize STEMI transfer times.
- The most important practices identified were prehospital electrocardiogram (ECG) performance and established inter-facility transfer protocols.
Conclusions:
- Prehospital ECGs and standardized transfer protocols are paramount for reducing STEMI patient transfer delays.
- These identified system practices should be integrated into the development and optimization of STEMI systems of care.
- Focusing on these critical factors can improve timely reperfusion and patient outcomes in STEMI.
Abstract:
Of patients with ST segment elevation myocardial infarction (STEMI), approximately two thirds present to a hospital not capable of percutaneous coronary intervention. Transfer to a STEMI-receiving center delays time to reperfusion in patients with STEMI, but factors that affect this delay have not been well studied. We performed a 3-round modified Delphi study to identify system practices that minimize transfer time to a STEMI-receiving center. A comprehensive literature review was used to identify candidate system practices. Emergency medical services, emergency medicine, and cardiology experts were invited to participate. Consensus was defined as 80% agreement that a variable was "very important (5)" or "important (4)" with a mean score ≥ 4.25 or 80% agreement that a variable was "not important (1)" or "somewhat important (2)" with a mean score ≤ 1.75. In round 1, participants rated the candidate items and suggested additional items. Individual feedback was provided, and participants discussed items via conference calls before rating them again in round 2. In round 3, participants ranked the consensus items from rounds 1-2 from most to least important, and the mean score for each item was calculated. Of the 98 experts invited, 29 participated in round 1, 22 in round 2, and 14 in round 3. Participants identified 18 system practices that they agree are critical in minimizing transfer time to STEMI-receiving centers, with the most important being performance of a prehospital electrocardiogram and having established transfer protocols. These factors should be considered in the development of STEMI systems of care.
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