A Pilot Rapid Triage Process for Prehospital ST-Segment Myocardial Infarction Patients Direct to the Catheterization
Matthew J Levy1,2, Asa Margolis1,3, Victoria Collins1
1Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
Cureus
|December 30, 2024
Summary
Implementing a "Direct to Lab" workflow significantly reduced treatment times for ST-elevation myocardial infarction (STEMI) patients arriving via Emergency Medical Services (EMS). This streamlined approach, prioritizing rapid percutaneous coronary intervention (PCI), improved key metrics without increasing complications.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Systems Management
Background:
- ST-elevation myocardial infarction (STEMI) requires rapid treatment with primary percutaneous coronary intervention (PCI) to minimize morbidity and mortality.
- Reducing total ischemic time is critical, with first-medical-contact-to-balloon (FMCTB) time serving as a key performance indicator.
- Optimizing workflows for Emergency Medical Services (EMS) STEMI patients presenting to the Emergency Department (ED) is essential for timely reperfusion.
Purpose of the Study:
- To evaluate the impact of a pilot "Direct to Lab" (DTL) workflow on reducing FMCTB times for EMS-STEMI patients.
- To compare treatment times and complication rates between the DTL workflow and the standard ED triage process.
Main Methods:
- A pre/post analysis was conducted at a community hospital, comparing a DTL workflow pilot to the standard STEMI patient management.
- Data from the hospital's STEMI database (2/1/2021–3/1/2024) included EMS STEMI alert activations.
- Inclusion criteria focused on hemodynamically stable STEMI patients arriving via EMS during weekday daytime hours; exclusions applied to off-hours arrivals or those requiring extensive ED stabilization.
Main Results:
- The DTL workflow resulted in significantly faster times: 8.4 minutes faster in the ED, 19.6 minutes faster for door-to-balloon (DTB), and 24.3 minutes faster for FMCTB.
- Complication rates were comparable between the DTL and standard workflow groups.
- The primary reasons stable patients did not utilize DTL included the need for further clinical evaluation or lab unavailability.
Conclusions:
- The pilot "Direct to Lab" workflow significantly reduced total ED, DTB, and FMCTB times for EMS-STEMI patients.
- This streamlined approach demonstrated patient-centered benefits without an increase in procedural complications.
- Effective collaboration between EMS, ED, and Interventional Cardiology is crucial for optimizing STEMI care pathways.
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