Author + information
- Yanina A. Purim-Shem-Tov,
- Gary Schaer,
- Kaleem Malik,
- Robert R. McLaughlin,
- Norma Melgoza,
- Janet Haw and
- Mary M. Franco
Patients with ST-segment elevation MI (STEMI) greatly benefit from a rapid door-to-balloon (D2B) time. For hospitals without a cath lab, it is imperative to establish partnerships with a STEMI receiving center (SRC). STEMI systems of care have been established to facilitate these relationships to improve rapid reperfusion. We describe the experience and benefits of such a relationship.
A partnership between our two institutions was established in April 2011. Saint Anthony Hospital (SAH) of Chicago is a community hospital with interventional cardiologists on staff, but no cath lab. Prior to the partnership, STEMI patients were transferred 8 miles to a PCI hospital on the city's north side. Rush University Medical Center (RUMC) is an academic medical center with 24/7/365 PCI capability. SAH decided that a transfer relationship with a closer SRC would benefit patient care. The following steps were taken: both hospitals signed a transfer agreement for STEMI transfers regardless of insurance status; an education process occurred at both hospitals; agreement that transferred patients would follow-up at the referring hospital (SAH); a contract with a single ambulance provider was signed; a simple STEMI protocol was adopted.
In 2010 SAH saw 20 STEMI patients. Average time from patient arrival to leaving the ED was 83 min; approximate transfer time to SRC was 25 min; time to PCI not available. Since the new protocol 16 patients transferred to RUMC for PCI in 2011 and 4 in 2012 to date. Median (min, max) time from ED arrival at referral hospital to SRC was 85 min (56, 192) in 2011; 97 minutes (71, 167) in 2012. Median time for ED arrival at SRC to 1st PCI device was 43.5 min (17, 84) in 2011, 28.5 min (26, 104) in 2012.
Streamlining STEMI patient care to reduce D2B is a major priority. We have demonstrated that establishing a transfer program between a STEMI referring hospital and SRC can markedly improve time to reperfusion. This approach has resulted in arrival at the referral hospital to first PCI device at the SRC that match or exceed the D2B for non-transfer patients at most STEMI receiving hospitals.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Pre-Hospital ECG and Transfer: Time Is Myocardium
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1212-180
- 2013 American College of Cardiology Foundation