Receiving Center Frequently Asked Questions (Interim)

  • Updated: Mar 28,2012

Click a question for the answer.

  • Realizing that all of these entities come to the table with their own agendas, priorities and concerns, Mission: Lifeline seeks to build a consensus around what is best for the patient according to data, guidelines, resources and local leadership.

  • Emergency medical service (EMS) providers and referral centers that initially treat patients prior to transferring to a receiving center often face a "black hole" experience. Once the patient is out of their care, they are left with questions about outcomes and whether their contributions to treatment helped achieve success. To improve quality of care and recognize the contribution that EMS and referral centers play in the treatment of STEMI and/or cardiac resuscitation patients, the receiving (PCI-capable) centers must close this communication gap.

    Furthermore, referral centers may feel that diverting or transferring STEMI and/or cardiac resuscitation patients to receiving hospitals will result in substantial lost revenue. While STEMI victims make up the minority of heart attack patients, this perceived economic threat to referral hospitals must be addressed.

  • Mission: Lifeline has defined progress markers for three key areas related to receiving centers, as shown in the table below.

    PROGRESS MARKERS

    Structure

    • Median (25th, 75th) arrival time for interventional cardiologist and staff at lab
    • Percentage of PCI hospitals that have predefined STEMI / cardiac resuscitation protocols (perhaps too low a bar)
    • Percentage of hospitals that have implemented a predefined management plan for emergency coronary bypass surgery (+/-)

    Process

    • Percent of patients eligible for reperfusion who receive it
    • Percent of patients receiving reperfusion who meet the American Heart Association / American College of Cardiology median (25th, 75th) recommended door-to-reperfusion time
    • Percent of eligible patients that receive door-to- reperfusion time of 90 minutes or less or door-to-needle time of 30 minutes or less
    • Median (25th, 75th) door-to- reperfusion n time and door-to- reperfusion time of less than 90 minutes as well as median (25th, 75th) door-to-needle time and door-to-needle time of less than 30 minutes for transfer patients
    • Median (25th, 75th) times for overall patient ischemic time overall and stratified by transfer status
    • Proportion of eligible patients administered guideline-based class I therapies

    Outcomes

    • Incidence of vascular complications
    • Angiographic success: Percent of stented lesions with angiographic success
    • Procedure success: Percent of procedures with angiographic success and no death, MI or emergent/salvage CABG during admission
    • In-hospital mortality, 30-day risk-adjusted mortality

  • Mission: Lifeline has defined progress markers for three key areas related to emergency departments, as shown in the table below.

    PROGRESS MARKERS

    Structure

    • Adequate staff, equipment and training to perform emergency department rapid evaluation, triage and treatment for any cardiac emergency
    • Presence of a single, standardized STEMI / cardiac resuscitation care pathway
    • Presence of a one-contact STEMI / cardiac resuscitation hotline

    Process

    • Door to first ECG time
    • Proportion of eligible patients receiving any reperfusion
    • Door-to-catheterization-laboratory time or door-to-disposition time
    • Proportion of patients ineligible for fibrinolytics but eligible for PCI