STEMI-Receiving Hospital Barriers & Solutions

Updated:Aug 12,2010

While STEMI-receiving hospitals have the expertise, facilities and equipment
to deliver percutaneous coronary intervention (PCI) to STEMI patients, they still have barriers to overcome as part of a STEMI system of care. The chart below examines these barriers and provides a list of solutions.

BARRIERSSOLUTIONS
Multiple interests regarding STEMI plan
  • Hospital administration: Build program and maintain PCI volume standards, great quality improvement (QI) numbers and payer contracts
  • Emergency department physician: Rapid disposition, litigation
  • EMS: Avoid delay in non-PCI hospital
  • Cardiology: Multiple private groups vs. academic or single cardiology group, provider volume
Build consensus around what is best for the patient according to:
  • Data
  • Guidelines
  • Resources
  • Local leadership

30-minute activation

  • Monitoring of team members and post times
  • At least one team member within a 15-minute call
  • CCU or house supervisor
No diversion: 24 hours a day, 7 days a week, 365 days a year
  • On-site sleeping facilities for staff
  • Policy changes
  • Advocacy
  • State/national level criteria

Simultaneous STEMIs

Plan in place with second call team member or nearby PCI center to cover

False activation and resource allocation

  • Definition
  • Monitor and feedback loop
  • Education and training
Emergency department (ED) walk-ins
Main ED delays