Abstract
Background: Delay in symptom recognition and calling 911 for patients with ST-segment elevation myocardial infarction (STEMI) continues to challenge many hospitals’ STEMI systems. Research has historically focused on door-to-balloon time and inpatient treatment, with little known on the impact of engaging emergency services (EMS) to provide a team approach to patient care, from community education to prehospital activation. Purpose: Evaluate the impact of a collaboration with local EMS agencies in our institution’s STEMI system designed to develop a prehospital protocol and joint community education efforts. Methods: Data collected from NCDR ACTION Registry-Mission Lifeline reports from 2011 to 2013 was analyzed to identify recent trends in prehospital STEMI quality metrics. After evaluation of 2011 data, a regional plan was developed and implemented in 2012 to address prehospital system barriers, including public education and revision of a prehospital protocol. Results: In 2011, a majority of patients used private transport when having a STEMI. Following protocol implementation, STEMI patients were able to identify symptoms earlier and appropriately call 911 earlier. As a result, a first medical contact (FMC)-to-balloon time of < 90 minutes increased to 72% of patients, time from symptom onset to balloon decreased, and postprocedure complication rate improved (Table). Conclusions: Establishing a collaborative prehospital protocol between hospitals and EMS can have a positive impact on outcomes in STEMI patients. With more awareness and earlier notification of incoming STEMI patients, hospitals can significantly decrease symptom onset-to-balloon time. Evaluation of time from symptom onset to device activation may be a better way to measure quality than door-to-balloon time, as evidenced by a decrease in postprocedure complications associated with decreased overall times.
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