Minimizing transfer time to an ST segment elevation myocardial infarction-receiving center: a modified Delphi...

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.