STEMI-Referring Hospitals Barriers & Solutions

Updated:Aug 23,2013

STEMI referring (non-PCI) hospitals must overcome a number of barriers
and preconceptions in order to play their ideal role within the STEMI system. The chart below examines these barriers and provides a list of solutions.

BARRIERSSOLUTIONS
Multiple interests regarding STEMI plan
  • Hospital administration: Keep patient, build volume
  • Emergency department physician: Rapid disposition, litigation
  • EMS: Avoid delay in non-PCI hospital
  • Cardiology local hospital: Keep patient
  • Cardiology at PCI hospital: Transfer patient
Multiple STEMI plans
Build consensus around what is best for the patient according to:
  • Data
  • Guidelines
  • Resources
  • Local leadership
  • Waiting room delays
  • Registration
  • Educate of registration labor regarding chest pain presentation
  • Nurse first

Lack of electrocardiogram (ECG) space

Provide privacy for an ECG in triage (convert a closet or curtain area)

  • Whose patient is it anyway?
  • Emergency department physician not empowered to make a reperfusion call

Change policy for ED medicine empowered to make reperfusion decision

EMTALA and transfer issues
  • Ensure protocol is in place for community
  • Accelerate EMTALA forms
  • Fax additional paperwork
Rural issues: Lytic ineligible, shock patientsHave a transfer plan in place and a back-up plan for rural areas