Abstract 13858: Improving the Compliance With the Use of ST Elevation Myocardial Infarction Cardiogenic Shock Protocol in an Urban Inner City Teaching Hospital- A Quality Initiative

Abstract

Background: 5-10% of STEMI are complicated by Cardiogenic shock (CGS). From multiple shock initiative across the country, the survival is shown to improve from 50% to 70-80%.Problem: 1) To evaluate the outcomes and identify gaps in treatment of STEMI complicated with CGS at our institution between Jan, 2018 to Dec, 2019. Based on this, a STEMI shock protocol was implemented at our institution. 2) After its implementation on 7/1/2020, the compliance with its use was measured and the goal is to increase from 30% (July - Dec) to 70% by the end of June 2021. Method: 178 cases with STEMI between 1/1/2018 to 12/31/2019 were reviewed.Patients were classified into: Identified CGS (A), Unidentified CGS (B, those that met criteria), Non-CGS (C, no criteria for CGS). Basic demographics, in-hospital mortality, 30-day mortality, length-of-stay (LOS), incidence of acute kidney injury (AKI) & acute liver injury (ALI) were measured. Results: In group A: average LOS was 16 d, mean LVEDP was 25 mmHg and in-hospital mortality/30-day mortality was 56.2% (9 pts)/62.5% (10 pts). 100% (16) had AKI, 25% (4) required new hemodialysis during that admission, 93.8% (15) had ALI and 100% (16) required vasopressors/inotropes.In group B: average LOS was 6 d, mean LVEDP was 24.5 mmHg and in-hospital mortality/30-day mortality was 0%/8.7% (2 pts).In group C: average LOS was 4 d, mean LVEDP was 20.6 mmHg and in-hospital/30-day mortality was 0%. After its implementation, the compliance rate was measured. It was estimated about 30%. A survey of 14 questions was sent out to all the involved providers. A Pareto chart was created and based on it, we provided more educational trainings, feedback programs and implemented order sets in the electronic medical record system. We will continue to measure improvement in the compliance over next PDSA cycles. This will ultimately help us evaluate any improvement in the outcomes in STEMI-CGS patients. Conclusions: This is a unique quality improvement project which will help improve patient outcomes in STEMI CGS patients. This is an attempt to standardize the care in our institution with a goal to early identify them and initiate measures derived from evidence-based practice.