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Factors affecting STEMI performance in six hospitals within one healthcare system

Joanne Thanavaro1, Paula Buchanan2, Maria Stiffler3

  • 1St. Louis University Trudy Busch Valentine School of Nursing, St. Louis, Missouri, USA.

Heart & Lung : the Journal of Critical Care
|June 9, 2021
PubMed

Insights

Field ECG activation significantly reduces door-to-balloon (D2B) time for ST-elevation myocardial infarction (STEMI) patients. Collaboration between hospitals and EMS is key to improving D2B times through early activation and direct transport to the cardiac catheterization lab.

Area of Science:

  • Cardiology
  • Healthcare Quality Improvement
  • Emergency Medicine

Background:

  • Door-to-balloon (D2B) time is a critical quality metric for percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients.
  • Timely intervention is crucial for improving outcomes in STEMI.

Purpose of the Study:

  • To investigate factors influencing STEMI treatment performance across six hospitals within a single healthcare system.
  • To identify predictors of D2B time in STEMI patients.

Main Methods:

  • Retrospective chart review analyzing clinical features and D2B times.
  • Multivariate linear regression used to identify predictors of D2B times.

Main Results:

  • Median D2B time was 63 minutes, with all hospitals exceeding the benchmark of 75% of patients achieving D2B time ≤90 minutes.
  • Patient-related factors were associated with a significant increase in D2B time (+21.5 minutes).
  • Field ECG activation with direct cardiac catheterization laboratory (CCL) transport significantly reduced D2B times compared to emergency department (ED) activation.

Conclusions:

  • Field ECG activation and STEMI activation protocols demonstrably shorten D2B times.
  • Enhanced collaboration between hospitals and Emergency Medical Services (EMS) is recommended to promote field activation and direct patient transport to the CCL for improved STEMI care.
Abstract

Keywords:
Direct patient transport to CCLDoor-to-balloon timeField ECG and STEMI activationPercutaneous coronary interventionST elevation myocardial infarction

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