Design of a standardized system for transfer of patients with ST-elevation myocardial infarction for percutaneous coronary intervention.
BACKGROUND
Direct percutaneous coronary intervention (PCI) is the preferred method of reperfusion for ST-elevation myocardial infarction (STEMI). Transfer from community hospitals to PCI centers increases availability for direct PCI, which improves outcomes compared to fibrinolysis in Europe. It has been difficult to achieve similar door-to-balloon times for transfer patients in the United States.


METHODS
We designed a standardized protocol and integrated system of transfer for patients with STEMI. We report the door-to-balloon times for the pre- and postpilot patients in the index hospital and describe the details of the current Level 1 MI Program.


RESULTS
In the 15 months before the pilot project, the door-to-balloon time for patients receiving ad hoc transfer for direct PCI was 192 minutes, similar to the national average. The door-to-balloon time for the patients receiving rescue PCI after failed thrombolysis was 221 minutes. The standardized protocol decreased door-to-balloon time to 98 minutes in the pilot trial (P < .01) and has now been applied successfully in 29 community hospitals.


CONCLUSIONS
Rapid transfer of patients with STEMI is feasible in the United States using a standardized protocol and integrated transfer system. This requires a team approach with cooperation between cardiologists, emergency physicians, nurses, and the emergency medical system as well as various health care organizations.
Henry
Timothy D
TD
Minneapolis Heart Institute Foundation, Minneapolis, Minnesota 55407, USA. henry003@umn.edu
Unger
Barbara Tate
BT
Sharkey
Scott W
SW
Lips
Daniel L
DL
Pedersen
Wesley R
WR
Madison
James D
JD
Mooney
Michael R
MR
Flygenring
Bjorn P
BP
Larson
David M
DM
D015906:Angioplasty, Balloon, Coronary; D002985:Clinical Protocols; D004562:Electrocardiography; D006764:Hospitals, Community / Q000592:standards*; D006801:Humans; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D010360:Patient Transfer / Q000592:standards*; D010865:Pilot Projects; D015397:Program Evaluation; D011996:Records; D012041:Regional Medical Programs; D013997:Time Factors; D013996:Time and Motion Studies