Comprehensive Hospital Care Improvement Strategies Reduce Time to Treatment in ST-Elevation Acute Myocardial Infarction

Lipton, Jonathan; Broce, Mike; Lucas, Dan; Mimnagh, Kathleen; Matthews, Anne; Reyes, Bernardo; Burdette, John; Wagner, Galen S.; Warren, Stafford G.

doi:10.1097/01.hpc.0000202248.77279.69

Cited by 10 publications

(4 citation statements)

References 12 publications

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“…Quality assurance, realtime feedback, and healthcare provider education can also reduce the time to therapy in STEMI. 89,[93][94][95][96][97] Involvement of hospital leadership in the process and commitment to support rapid access to STEMI reperfusion therapy are critical factors associated with successful programs.…”

Section: Systems Of Carementioning

confidence: 99%

Part 10: Acute Coronary Syndromes

O’Connor¹,

Brady²,

Brooks³

et al. 2010

Circulation

240

167

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Section: Systems Of Carementioning

confidence: 99%

Part 10: Acute Coronary Syndromes

O’Connor¹,

Brady²,

Brooks³

et al. 2010

Circulation

240

167

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“…Care processes associated with shorter door to balloon times are presented in Table 4 and include: ER physician activates cath lab (including several variations) [80,[82][83][84]88,93,95,100], single call to a central page to activate cath lab [78,100], requiring that staff arrive within 20 min of page [100], ER activating cath lab while patient is en route [100], ER and cath lab receiving real time feedback [100], attending cardiologist always on site [100], passive monitoring of physician performance [92], obtaining a pre-hospital ECG (including several variations) [15,16,23,25,29,35,37,57,63,64,77,97], initial culprit vessel PCI before full diagnostic angiography [19,46] and initiation of a quality improvement initiative or critical pathway [17,79,87,[89][90][91]94,96,99]. Longer times are reported with improperly low initial triage of emergency patients with STEMI [66] and use of an intraaortic balloon pump [5].…”

Section: Care Processesmentioning

confidence: 99%

A systematic review of factors predicting door to balloon time in ST-segment elevation myocardial infarction treated with percutaneous intervention

Peterson

Syndergaard

Bowler

et al. 2012

International Journal of Cardiology

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“…662,663 Twelve studies demonstrated that emergency physician activation of the catheterization laboratory was associated with significant reductions in door-to-balloon time intervals (20 to 68 minutes) (LOE 2 664 -666 ; LOE 3 [667][668][669][670][671][672][673] ; LOE 5 663,674 ). Falsepositive activation rate in these studies ranged from 0% to 15%.…”

Section: Consensus On Science Emergency Physician or Prehospital Actimentioning

confidence: 99%

“…Falsepositive activation rate in these studies ranged from 0% to 15%. 674,[663][664][665][666][667][668][669][670][671][672][673] Prehospital Activation of the Catheterization Laboratory. Seven studies demonstrated the effectiveness of prehospital activation on reducing door-to-balloon time intervals (22 to 69 minutes) (LOE 2 656,675 ; LOE 3 676,677 ; LOE 4 660,678 ).…”

Section: Consensus On Science Emergency Physician or Prehospital Actimentioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

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Comprehensive Hospital Care Improvement Strategies Reduce Time to Treatment in ST-Elevation Acute Myocardial Infarction

Abstract: Implementation of HCIS shortened door-to-PCI time for patients with STEMI by 39.2 +/- 10 minutes. Thus, HCIS may be effective in improving patient outcomes.

Cited by 10 publications

References 12 publications

Part 10: Acute Coronary Syndromes

Part 10: Acute Coronary Syndromes

A systematic review of factors predicting door to balloon time in ST-segment elevation myocardial infarction treated with percutaneous intervention

Part 9: Acute Coronary Syndromes

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