Association of Rapid Care Process Implementation on Reperfusion Times Across Multiple ST-Segment-Elevation Myocardial Infarction Networks

Circ Cardiovasc Interv. 2017 Jan;10(1):e004061. doi: 10.1161/CIRCINTERVENTIONS.116.004061.

Abstract

Background: The Mission: Lifeline STEMI Systems Accelerator program, implemented in 16 US metropolitan regions, resulted in more patients receiving timely reperfusion. We assessed whether implementing key care processes was associated with system performance improvement.

Methods and results: Hospitals (n=167 with 23 498 ST-segment-elevation myocardial infarction patients) were surveyed before (March 2012) and after (July 2014) program intervention. Data were merged with patient-level clinical data over the same period. For reperfusion, hospitals were grouped by whether a specific process of care was implemented, preexisting, or never implemented. Uptake of 4 key care processes increased after intervention: prehospital catheterization laboratory activation (62%-91%; P<0.001), single call transfer protocol from an outside facility (45%-70%; P<0.001), and emergency department bypass for emergency medical services direct presenters (48%-59%; P=0.002) and transfers (56%-79%; P=0.001). There were significant differences in median first medical contact-to-device times among groups implementing prehospital activation (88 minutes implementers versus 89 minutes preexisting versus 98 minutes nonimplementers; P<0.001 for comparisons). Similarly, patients treated at hospitals implementing single call transfer protocols had shorter median first medical contact-to-device times (112 versus 128 versus 152 minutes; P<0.001). Emergency department bypass was also associated with shorter median first medical contact-to-device times for emergency medical services direct presenters (84 versus 88 versus 94 minutes; P<0.001) and transfers (123 versus 127 versus 167 minutes; P<0.001).

Conclusions: The Accelerator program increased uptake of key care processes, which were associated with improved system performance. These findings support efforts to implement regional ST-segment-elevation myocardial infarction networks focused on prehospital catheterization laboratory activation, single call transfer protocols, and emergency department bypass.

Keywords: ST-segment–elevation myocardial infarction; percutaneous coronary intervention; quality improvement; reperfusion times; systems of care.

Publication types

  • Evaluation Study
  • Multicenter Study

MeSH terms

  • Cardiac Catheterization
  • Cardiology Service, Hospital / organization & administration
  • Critical Pathways / organization & administration
  • Delivery of Health Care, Integrated / organization & administration*
  • Delivery of Health Care, Integrated / standards
  • Emergency Medical Services / organization & administration
  • Emergency Service, Hospital / organization & administration
  • Hospital Mortality
  • Humans
  • Myocardial Reperfusion / adverse effects
  • Myocardial Reperfusion / methods*
  • Myocardial Reperfusion / mortality
  • Myocardial Reperfusion / standards
  • Patient Transfer / organization & administration
  • Process Assessment, Health Care / organization & administration*
  • Process Assessment, Health Care / standards
  • Program Evaluation
  • Quality Improvement
  • Quality Indicators, Health Care
  • Registries
  • ST Elevation Myocardial Infarction / diagnosis
  • ST Elevation Myocardial Infarction / mortality
  • ST Elevation Myocardial Infarction / therapy*
  • Time Factors
  • Time-to-Treatment / organization & administration*
  • Time-to-Treatment / standards
  • Treatment Outcome
  • Vereinigte Staaten