title: Rapid triage and transport of patients with ST-elevation myocardial infarction for percutaneous coronary intervention in a rural health system.
abstract: This study was conducted to evaluate door-to-treatment times before and after the implementation of a rapid triage and transfer system for patients with ST-elevation myocardial infarction transferred from community hospitals to a rural angioplasty center for primary percutaneous coronary intervention (PCI). The system was developed in late 2004 and implemented at a rural percutaneous coronary intervention center in early 2005. Helicopter transport was available for 97% of requests for transfer from community hospitals. All patients with ST-elevation myocardial infarction transferred during 2004 and 2005 (n=226) were evaluated with respect to presentation and treatment times. Time from community hospital presentation to wire crossing decreased during the study from 205 to 105 minutes (p=0.0001). One fourth of patients were treated <90 minutes after presentation, and 2/3 were treated in <120 minutes. In conclusion, the implementation of a rapid triage, transfer, and treatment protocol can achieve a significant shortening of presentation-to-treatment times. Efficient community hospitals working with an efficient angioplasty center can achieve presentation-to-wire crossing times of <90 minutes for some patients.
authors.affiliation: Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania, USA. jblankenship@geisinger.edu
authors.forename: James C
authors.initials: JC
authors.lastname: Blankenship
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Haldis
authors.forename: G Craig
authors.initials: GC
authors.lastname: Wood
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Skelding
authors.forename: Thomas
authors.initials: T
authors.lastname: Scott
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Menapace
mesh_terms: D000368:Aged; D017732:Air Ambulances; D015906:Angioplasty, Balloon, Coronary; D002985:Clinical Protocols; D017598:Efficiency, Organizational; D005260:Female; D006764:Hospitals, Community / Q000458:organization & administration* / Q000592:standards; D006780:Hospitals, Rural / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010360:Patient Transfer / Q000592:standards*; D012041:Regional Medical Programs; D019035:Rural Health Services / Q000458:organization & administration* / Q000592:standards; D013996:Time and Motion Studies; D014218:Triage