Abstract 155: Improving ST-Elevation Myocardial Infarction Care with Site-specific Reperfusion Goals for Interfacility Transfers

Abstract

Introduction: Optimizing interfacility transfer of STEMI patients for emergent PCI remains a challenge due to difficulty calculating a customized time goal for transfer from a single non-PCI to PCI center (known as a “STEMI conduit”). Here we propose a simple formula to calculate conduit-specific interfacility STEMI transfer goals, allowing hospitals to assess and optimize their performance. Hypothesis: Optimal time for individual STEMI transfers within a STEMI conduit can be reliably calculated with the formula (V1+ V2 + 60 minutes). In this formula, V1 is the optimal EMS response time to the transferring facility (in minutes) and V2 is the interfacility (door-to-door) transfer time (in minutes). V1 and V2 are site-specific and vary across STEMI conduits. The additional 60 minutes represents the sum of the goal Door to Decision, EMS Scene Turn-around, and PCI Door to Reperfusion times. The goal times for these individual parameters are based on established expectations or national best practices and remain constant for all STEMI conduits. Using this formula, the expected facility-to-facility transfer time [F2F(expected)] can be calculated and this value can then be compared to actual performance [F2F(observed)] with the ratio of observed/expected performance. A ratio close to 1 suggests the transfer occurred in a realistic yet optimized time frame. Methods: Interfacility STEMI transfers occurring within five STEMI conduits over four years were evaluated retrospectively. A performance goal was determined for each conduit using the formula [F2F(expected) = V1 + V2 + 60 minutes] and a ratio of F2F(observed /expected) was calculated for each transfer. Results: The figure demonstrates the F2F ratio ranges and means for transfers within each conduit. Four of five conduits exhibit mean ratios close to 1, indicating that the calculated expected performance is representative of what is optimized and sustainable within that conduit. The remaining conduit has a mean ratio of 0.81 indicating observed performance better than predicted. Conclusion: The proposed formula [F2F(expected) = V1 + V2 + 60 minutes] can be used to accurately calculate interfacility transfer goals for STEMI conduits and can thereby serve as a marker for quality improvement, enabling hospitals to monitor and optimize STEMI transfer performance.