Bypassing the Emergency Department to Improve the Process of Care for ST-Elevation Myocardial Infarction

Background ST-elevation myocardial infarction (STEMI) remains the second leading cause of death in Canada. Primary percutaneous coronary intervention (PCI) has been recognized as an effective method for treating STEMI. Improved access to primary PCI can be achieved through the implementation of regional PCI centres, which was the impetus for implementing the PCI program in an east Toronto hospital in 2009. As such, the purpose of this study was to measure the efficacy of this program regional expansion. Methods A retrospective review of 101 patients diagnosed with STEMI from May to Sept 2010 was conducted. The average door-to-balloon time for these STEMI patients was calculated and the door-to-balloon times using different methods of arrival were analyzed. Method of arrival was by one of three ways: paramedic initiated referral; patient walk-ins to PCI centre emergency department; or transfer after walk-in to community hospital emergency department. Results The study found that mean door-to balloon time for PCI was 112.5 minutes. When the door-to-balloon times were compared across the three arrival methods, patients who presented by paramedic-initiated referral had significantly shorter door-to-balloon times, (89.5 minutes) relative to those transferred (120.9 minutes) and those who walked into a PCI centre (126.7 minutes) (p = 0.047). Conclusions The findings suggest that the partnership between the hospital and its EMS partners should be continued, and paramedic initiated referral should be expanded across Canada and EMS systems where feasible, as this level of coverage does not currently exist nationwide. Investments in regional centres of excellence and the creation of EMS partnerships are needed to enhance access to primary PCI.

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Evaluation of a regional ST-elevation myocardial infarction primary percutaneous coronary intervention program at the Rouge Valley Health System

10.32920/14639403 ◽

2021 ◽

Author(s):

Pria MD Nippak ◽

Jodie Pritchard ◽

Robin Horodyski ◽

Candace J Ikeda-Douglas ◽

Winston W Isaac

Keyword(s):

Myocardial Infarction ◽

Emergency Department ◽

Percutaneous Coronary Intervention ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Primary Pci ◽

Percutaneous Coronary ◽

St Elevation ◽

Door To Balloon

Background ST-elevation myocardial infarction (STEMI) remains the second leading cause of death in Canada. Primary percutaneous coronary intervention (PCI) has been recognized as an effective method for treating STEMI. Improved access to primary PCI can be achieved through the implementation of regional PCI centres, which was the impetus for implementing the PCI program in an east Toronto hospital in 2009. As such, the purpose of this study was to measure the efficacy of this program regional expansion. Methods A retrospective review of 101 patients diagnosed with STEMI from May to Sept 2010 was conducted. The average door-to-balloon time for these STEMI patients was calculated and the door-to-balloon times using different methods of arrival were analyzed. Method of arrival was by one of three ways: paramedic initiated referral; patient walk-ins to PCI centre emergency department; or transfer after walk-in to community hospital emergency department. Results The study found that mean door-to balloon time for PCI was 112.5 minutes. When the door-to-balloon times were compared across the three arrival methods, patients who presented by paramedic-initiated referral had significantly shorter door-to-balloon times, (89.5 minutes) relative to those transferred (120.9 minutes) and those who walked into a PCI centre (126.7 minutes) (p = 0.047). Conclusions The findings suggest that the partnership between the hospital and its EMS partners should be continued, and paramedic initiated referral should be expanded across Canada and EMS systems where feasible, as this level of coverage does not currently exist nationwide. Investments in regional centres of excellence and the creation of EMS partnerships are needed to enhance access to primary PCI.

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Breaking down walls: a qualitative evaluation of perceived emergency department delays for patients transferred with ST-elevation myocardial infarction

BMC Emergency Medicine ◽

10.1186/s12873-020-00355-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Michael J. Ward ◽

Timothy J. Vogus ◽

Kemberlee Bonnet ◽

Kelly Moser ◽

David Schlundt ◽

...

Keyword(s):

Myocardial Infarction ◽

Emergency Department ◽

Qualitative Evaluation ◽

St Elevation Myocardial Infarction ◽

St Elevation

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Benchmarking as a quality of care improvement tool for patients with ST-elevation myocardial infarction: an NCDR ACTION Registry experience in Latin America

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzz115 ◽

2019 ◽

Vol 32 (1) ◽

pp. A1-A8

Author(s):

Adriano Caixeta ◽

Marcelo Franken ◽

Marcelo Katz ◽

Pedro A Lemos ◽

Ivanise Gomes ◽

...

Keyword(s):

Myocardial Infarction ◽

Quality Of Care ◽

Angiotensin Receptor Blockers ◽

Coronary Intervention ◽

Hospital Performance ◽

St Elevation Myocardial Infarction ◽

Process Of Care ◽

Converting Enzyme Inhibitors ◽

St Elevation

Abstract Objective We aim to examine the effect of benchmarking on quality-of-care metrics in patients presenting with ST-elevation myocardial infarction (STEMI) through the implementation of the American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) ACTION Registry. Design From January 2005 to December 2017, 712 patients underwent primary percutaneous coronary intervention PCI—499 before NCDR ACTION Registry implementation (prior to 2013) and 213 after implementation. Setting STEMI. Participants 712 patients. Intervention(s) Primary PCI. Main Outcome Measure(s) We examined hospital performance for the quality indicators in processes and outcomes of the management of patients presenting with STEMI. Outcome measures include door-to-balloon time (DBT), antiplatelet therapy and anti-ischemic drugs prescribed at discharge from pre-NCDR ACTION Registry to post-implementation. Results There was improvement in DBT, decreasing from 94 min in 2012 (before NCDR adoption) to reach a median of 47 min in 2017 (Ptrend < 0.001). The percentage of cases with the optimal DBT of < 90 min increased from 55.8% before to 90.1% after the implementation of the NCDR ACTION Registry (Ptrend < 0.001). The rate of aspirin (90.3–100%, P < 0.001), P2Y12 inhibitor (70.1–78.4%, P = 0.02), beta-blocker (76.8–100%, P < 0.001) and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (60.1–99.5%, P < 0.001) prescribed at discharge increased from pre-NCDR ACTION Registry to post-implementation. Adjusted mortality before and after NCDR ACTION Registry implementation showed significant change (from 9.04 to 5.92%; P = 0.027). Conclusions The introduction of the ACC NCDR ACTION Registry led to incremental gains in the quality in STEMI management through the benchmarking of process of care and clinical outcomes, achieving reduced DBT, improving guideline-directed medication adherence and increasing patient safety, treatment efficacy and survival.

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