Click the following questions for the answer.
1. Is bringing timely percutaneous coronary intervention (PCI) a realistic goal for all STEMI patients in this country?
PCI, when administered within the 90-120 minute door-to-balloon window, is the preferred method of treatment. However, because of geographical barriers, inclement weather, patient hesitation in seeking help or other delays, it’s not always possible. The longer it takes to administer PCI to a patient, the less beneficial that treatment is compared with timely administration of clot-busting pharmaceuticals. Timely fibrinolytis for eligible patients, are better than delayed PCI, and all patients deserve quick reperfusion of some sort. Therefore, non-PCI hospitals will always be key STEMI portals across the nation. Optimizing care at STEMI-referring centers should be a priority in STEMI improvement efforts, not just an afterthought.
2. When EMS circumvents the nearby referring center to transport a patient directly to a receiving center (PCI-capable), will the referring center encounter significant financial loss?
Referring center administrators may see Mission: Lifeline as a threat to their revenue generation. However, it’s important to keep in mind that the majority of heart attack patients suffer non-STEMI events and in many of these cases transport to a PCI hospital is not necessary. STEMI however, represents a true medical emergency and these patients need to have access to a PCI center even if they have received fibrinolysis, as soon as possible. This fact limits the financial impact on referring centers.
3. How do referring centers overcome the frustration of not knowing what happens to a patient who is transferred from their care to a receiving (PCI-capable) center?
Mission: Lifeline seeks to improve communication between all parties involved in a system of care. Currently, emergency medical services organizations and referring centers are often left with questions about the outcome of patients once they are transferred out of their care. As recommended by the Mission: Lifeline initiative, follow-up data is to be provided to all parties who were involved in administering care to a patient prior to transfer. By closing the communication loop, the various entities in the system will be informed of patient outcomes, and this data will be valuable in helping them gauge success and determine action items to improve the quality of care.