121 Analysis of Inter-facility Transfer Rates After Initiation of a Regional PCI System

Abstract

Background: Regionalization of percutaneous cardiac intervention (PCI) ST-segment elevation myocardial infarction (STEMI) systems has become ubiquitous in emergency medical services. Patients identified as out-of-hospital STEMIs have been demonstrated to have shorter 911-to-balloon times based on the out-of-hospital electrocardiogram. Direct reception of STEMI patients to these centers for intervention is increasingly becoming standard of care. However, the overall impact of Emergency Medical Services STEMI system transfer rates from non-PCI centers is not well characterized.Study Objective: To evaluate the impact of an emergency medical services STEMI system on the disposition of emergent PCI patients.Methods: This is an institutional review board-approved cohort analysis of interfacility transfers in a closed system of regional hospitals. The hospital system consisted of 4 hospitals with one becoming designated as PCI receiving center. The study population included all emergent PCIs in this system before and after implementation, which included out-of-hospital ECG transmission capabilities. Descriptive statistics analysis of emergent interfacility transfers for PCI before and after was completed along with a sub-analysis on STEMI patients. 911-to-balloon times were also compared.Results: A total of 399 emergent cardiac catheterizations were recorded during the study period (195 pre, 204 post). Transfers for emergent PCI decreased following STEMI system implementation from 36.4% (71/195) to 26.5% (54/204) (OR 1.59, 1.03–2.44). The difference in percentage of transfers for emergent PCI in STEMI patients was not statistically significant (28% to 22%, OR 1.24, 0.70–2.19). Time to PCI from initial ED/ emergency medical services contact was dramatically reduced.Conclusion: A regional emergency medical services PCI system reduces the percentage of transfers as well as time to emergent PCI. Patients suspected of having STEMIs were diverted away from receiving facilities without emergent PCI capability though emergent transfers from non-PCI centers still occurred in this system. Background: Regionalization of percutaneous cardiac intervention (PCI) ST-segment elevation myocardial infarction (STEMI) systems has become ubiquitous in emergency medical services. Patients identified as out-of-hospital STEMIs have been demonstrated to have shorter 911-to-balloon times based on the out-of-hospital electrocardiogram. Direct reception of STEMI patients to these centers for intervention is increasingly becoming standard of care. However, the overall impact of Emergency Medical Services STEMI system transfer rates from non-PCI centers is not well characterized. Study Objective: To evaluate the impact of an emergency medical services STEMI system on the disposition of emergent PCI patients. Methods: This is an institutional review board-approved cohort analysis of interfacility transfers in a closed system of regional hospitals. The hospital system consisted of 4 hospitals with one becoming designated as PCI receiving center. The study population included all emergent PCIs in this system before and after implementation, which included out-of-hospital ECG transmission capabilities. Descriptive statistics analysis of emergent interfacility transfers for PCI before and after was completed along with a sub-analysis on STEMI patients. 911-to-balloon times were also compared. Results: A total of 399 emergent cardiac catheterizations were recorded during the study period (195 pre, 204 post). Transfers for emergent PCI decreased following STEMI system implementation from 36.4% (71/195) to 26.5% (54/204) (OR 1.59, 1.03–2.44). The difference in percentage of transfers for emergent PCI in STEMI patients was not statistically significant (28% to 22%, OR 1.24, 0.70–2.19). Time to PCI from initial ED/ emergency medical services contact was dramatically reduced. Conclusion: A regional emergency medical services PCI system reduces the percentage of transfers as well as time to emergent PCI. Patients suspected of having STEMIs were diverted away from receiving facilities without emergent PCI capability though emergent transfers from non-PCI centers still occurred in this system.