Opportunities to Improve STEMI Systems of Care

6 Universal Opportunities to Improve STEMI Systems of Care

Pre-Hospital Cath Lab Activation Protocols

911 EMS Destination Protocols

Door In - Door Out at Referring Hospital

Transfer for PCI Protocols

Feedback Loops

Sign and Symptom Onset to Seeking Medical Help

 

Participants and Desired Outcomes

Opportunity Multidisciplinary Team Participants (May include additional team members) Desired Outcomes

Pre-Hospital Cath Lab Activation Protocols
  • EMS Leadership
  • EMS Training Officer
  • Receiving Center ED Physicians
  • Cardiologists
  • Receiving Center ED Nursing
  1. Protocol developed and implemented that allows cath lab team activation to occur prior to EMS arrival with a confirmed STEMI patient
  2. EMS providers notify ED as early as possible of an incoming STEMI patient
911 EMS Destination Protocols
  • 911 Emergency Dispatch
  • EMS Leadership
  • EMS Medical Director
  • EMS Training Officer
  • STEMI Referring Hospital Representative
  1. EMS providers transport the STEMI patient to the most appropriate hospital (even if located outside of the typical service area)
  2. EMS providers are empowered to by-pass the closest STEMI Referring hospital when EMS First Medical Contact to PCI can be achieved in <90 Minutes or <120 Minutes when transport time is ≥45 Minutes
Door In - Door Out at STEMI Referring Hospitals for the STEMI patient transferring out for Primary PCI
  • Interfacility Transport EMS Leadership (might be 911 EMS service)
  • STEMI Referring Hospital ED Physicians
  • STEMI Referring Hospital ED Nursing
  • STEMI Receiving Center Outreach Coordinator
  1. Primary STEMI reperfusion strategy plan in place
  2. Automatic acceptance plan in place with STEMI Receiving Centers
  3. Arrival to 12 Lead ECG ≤10 Minutes (walk in patient with cardiac chest pain)
  4. Primary detailed transfer plan in place
  5. Interfacility transport with emergent response
  6. Minimal time at bedside after Interfacility transport team arrival
  7. Recurrent STEMI Receiving Center outreach
Transfer for PCI Protocols
  • Interfacility Transport EMS Leadership (might be 911 EMS service)
  • STEMI Referring Hospital ED Physicians
  • STEMI Referring Hospital ED Nursing
  • STEMI Receiving Center Outreach Coordinator
  1. Primary and back-up transfer plans in place
  2. Automatic acceptance plan in place with STEMI Receiving Centers
  3. One-Call STEMI Alert Process
Feedback Loops
  • 911 EMS Leadership
  • Interfacility Transport Leadership
  • EMS Training Officers
  • Medical First Responders
  • 911 Emergency Dispatch
  • STEMI Receiving Center Outreach Coordinator
  • STEMI Receiving Center ED Physicians
  • Cardiologists
  • STEMI Referring representative
  1. Immediate feedback provided to EMS at ED bedside
  2. 24-48 feedback provided for every possible STEMI patient
  3. Multidisciplinary STEMI meetings include all participants, held monthly/quarterly and are collaborative
  4. All feedback forms look alike, no matter which hospital prepared them
  5. All feedback loop addressed - STEMI Receiving Center to EMS, 911 and Interfacility transport and to STEMI Referring hospital. STEMI Referring hospital to EMS, 911 and Interfacility transport. 911 EMS to Medical First Responders and dispatch
Sign and Symptom Onset to Seeking Medical Help
  • Media Outlets
  • Survivors
  • Lay Public
  • STEMI Receiving Center Leadership and Outreach
  • STEMI Referring Leadership
  • EMS Leadership
  1. Increase use of 911 for STEMI patients
  2. Decrease the time from sign and symptom onset to the time medical attention is sought

Although the opportunities to improve STEMI Systems of Care and the desired outcomes are universal, each regional/local barrier identified requires local solutions capitalizing on or acquiring new local resources. The preferred implementation approach is through a multidisciplinary team approach identifying gaps in care, process improvement opportunities and potential solutions. Every STEMI System of Care is in constant flux and because of this, individual EMS agency, hospital and total system performance should be continuously monitored. Changes can and do occur – new laws are passed, EMS agencies and hospitals gain or lose resources, new leadership is in place, new guidelines are released and etc. Each change is a new opportunity. Each opportunity addressed = lives saved!

Contact [email protected] and get connected with your local AHA Mission: Lifeline Quality Outcomes, Research and Analytics Director who can assist with:

  • STEMI Systems of Care Implementation Strategies
  • STEMI System of Care Assessments
  • Get With The Guidelines®- Coronary Artery Disease Enrollment for AMI Data collection
  • Participation in Mission: Lifeline Regional Reports
  • Get With The Guidelines - Coronary Artery Disease Super User Access
  • Convening Stakeholders
  • Quality, Process Improvement and Certification consultative services
  • Mission: Lifeline® Recognition Support (Hospital and EMS)

Last Reviewed: Jun 29, 2018