In the ideal system, pre-hospital ECG diagnosis of STEMI, ED notification and catheterization laboratory activation would occur according to standard algorithms that would facilitate a short ED stay or transport directly from the field to the catheterization laboratory. Similarly, single call systems from STEMI-referral hospitals with universal patient acceptance by STEMI-receiving hospitals would result in immediate activation of the catheterization laboratory team without the need for additional review or determination of bed availability.
Primary PCI would be provided as routine treatment for appropriate STEMI patients 24 hours per day and seven days per week and STEMI-receiving hospitals would never be on diversion. Each STEMI-receiving hospital would have a written commitment from the hospital's administration to support the program. A multidisciplinary group with representation for the ED, EMS, the cardiac catheterization laboratory, the quality improvement team, and the coronary care unit that includes both physicians and nurses would meet regularly to identify problems and implement solutions. A formal continuing education program that includes practical implementation training for staff would be designed and instituted. A mechanism for monitoring program performance, process measures, and patient outcomes would be established.
Refer to the Mission: Lifeline recommendations below for outcomes and measurements for quality improvement recognition.
The Mission: Lifeline Recognition Program will acknowledge PCI/STEMI-Receiving Centers for their efforts to improve quality of care for STEMI patients. This is the second level of involvement. Receiving Centers should participate in the approved Mission: Lifeline national registry program, ACTION Registry-GWTG. All achievement measures will be considered in the composite score. All reporting measures will be reviewed and collected but will not be used in the composite score. Applications for consideration will be available on Jan.1, 2010.
• 85 percent or greater composite score with no single measure below 75 percent on the following achievement measures for specified periods
• Bronze = 90 consecutive days, Silver = 12 consecutive months, Gold = 24 or more consecutive months
• Annual award period for consideration = January-December
• Annual award submission period = Jan. 1-March 31 following year
STEMI- Receiving Center Achievement Measures:
1. Percentage of STEMI patients with a door-to-balloon (first device used) time within 90 minutes, non-transfer
2. Percentage of STEMI patients with first medical contact to balloon inflation (first device used) time within 90 minutes, non-transfer
3. Percentage of reperfusion –eligible patients receiving any reperfusion (PCI or fibrinolysis) therapy)
4. Percentage of STEMI patients receiving aspirin within 24 hours
5. Percentage of STEMI patients on aspirin at discharge
6. Percentage of STEMI patients on beta blocker at discharge
7. Percentage of STEMI patients with LDL>100 who receive statins or lipid lowering drugs
8. Percentage of STEMI patients with left ventricular systolic dysfuntion on ACEI/ARB at discharge
9. Percentage of STEMI patients that smoke with smoking cessation counseling at discharge
STEMI- Receiving CenterReporting Measures (not considered in composite):
1. In-hospital mortality
2. Percentage of STEMI patients with a first medical contact to balloon inflation (first device used) time within 90 minutes, transfer
3. Percentage of STEMI patients with a STEMI Referral Hospital door-to-balloon (first device used) time within 90 minutes, transfer
4. Percentage of STEMI patients with a STEMI-Receiving Hospital door- to-balloon (first device used) time within 90 minutes, transfer