Strategies for the Ideal STEMI-Referral Hospital

Updated:Aug 23,2013

Mission: Lifeline has defined strategies for the ideal STEMI referring (non-PCI) hospital
so it makes its optimal contribution to the STEMI system of care. These strategies include:

  • Senior management commitment to best STEMI care and demonstration of this commitment through the provision of adequate resources to establish an optimal system
  • Establish a predetermined, institution-specific, written protocol for rapid reperfusion agreed upon by all cardiology and emergency department physicians and staff that includes criteria for rapid transfer to STEMI-Receiving Hospital for PCI
  • Emergency physician on duty activates the reperfusion plan according to established local guidelines / care pathways.
  • Prompt identification of patients requiring ECG through nurse interview prior to registration or registration personnel training
  • All patients presenting to ED with possible symptoms of STEMI to undergo ECG within 10 minutes regardless of room or nurse availability
  • For continued symptoms of STEMI, repeat the 12 lead ECG and/or continuous ST-segment monitoring.
  • Specify system for rapidly acquiring ECG including having ECG equipment in the ED and specifying a location that affords prompt access and adequate patient privacy
  • Reperfusion checklist for hospitals with a predetermined plan for fibrinolysis
  • Door in-door out time goal within 30 minutes for hospitals with a predetermined plan for transfer for PCI, and for patients ineligible for fibrinolysis or in cardiogenic shock
  • Overall system goal of first medical contact to balloon within 90 minute
  • Establish compatible intravenous tubing and pumps for potential transfer patients. May be changed to established hospital system if admitted.
  • Standard pharmacologic regimen for all STEMI patients agreed upon by all cardiology and emergency department physicians
  • Patient registration should be treated in a fashion similar to trauma patients with the ability to fast-track critical labs, such as creatinine and PT/INR.
  • Establish initial and backup plan for transfer / transport to a STEMI-Receiving hospital.
  • Establish compatible intravenous tubing and pumps for potential transfer patients.
  • Data collection and rapid feedback to representatives from all involved groups
  • In rural geography when rapid transport to STEMI-Receiving hospital unavailable for medical contact to balloon inflation within guideline goal or in urban/suburban areas where regular and backup plan for rapid transport is unavailable:
    o Door to needle time within 30 minutes for hospitals with a predetermined plan for fibrinolysis
    o Fibrinolytic agent stored in the Emergency Department and the intensive care unit.
    o Ability to reconstitute and administer fibrinolytic in Emergency Department.
    o If contraindication to fibrinolysis or uncertain diagnosis, expedited transfer plan to STEMI-Receiving hospital.
    o Ongoing training and assessment program