title: Overcoming barriers to developing seamless ST-segment elevation myocardial infarction care systems in the United States: recommendations from a comprehensive Prehospital 12-lead Electrocardiogram Working Group.
abstract: BACKGROUND
  Reducing time to reperfusion treatment for patients with ST-segment elevation myocardial infarction (STEMI) improves patient outcomes. Few medical systems consistently meet current benchmarks regarding timely access to treatment. Studies have widely demonstrated that prehospital 12-lead electrocardiography can facilitate early catheterization laboratory activation and is the most effective means of decreasing patients' time to treatment.
  
  
  METHODS
  We gathered experts to examine the barriers to implementation of prehospital 12-lead electrocardiographic monitoring and transmission to in-hospital cardiologists in creating seamless STEMI care systems (STEMI-CS) and propose multidisciplinary approaches to overcoming these barriers.
  
  
  CONCLUSIONS
  Physicians, hospital systems, and emergency medical services often lack coordination of care delivery and receive fragmented funding and oversight. Clinical and regulatory guidelines do not emphasize local solutions to achieving clinical benchmarks, do not target incentives at all components of the STEMI-CS, and underemphasize risk-based approaches to protecting patient health. Integration of the multiple complex components involved in STEMI-CS is essential to improving care delivery.
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, NC 27705, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Frendl
authors.forename: Sebastian T
authors.initials: ST
authors.lastname: Palmeri
authors.forename: J Robert
authors.initials: JR
authors.lastname: Clapp
authors.forename: David
authors.initials: D
authors.lastname: Hampton
authors.forename: Maria
authors.initials: M
authors.lastname: Sejersten
authors.forename: Dwayne
authors.initials: D
authors.lastname: Young
authors.forename: Barbara
authors.initials: B
authors.lastname: Drew
authors.forename: Robert
authors.initials: R
authors.lastname: Farrell
authors.forename: Jan
authors.initials: J
authors.lastname: Innes
authors.forename: James
authors.initials: J
authors.lastname: Russell
authors.forename: G Ian
authors.initials: GI
authors.lastname: Rowlandson
authors.forename: Yanina
authors.initials: Y
authors.lastname: Purim-Shem-Tov
authors.forename: B Kevin
authors.initials: BK
authors.lastname: Underhill
authors.forename: Sophia
authors.initials: S
authors.lastname: Zhou
authors.forename: Galen S
authors.initials: GS
authors.lastname: Wagner
mesh_terms: D019985:Benchmarking / Q000592:standards; D002309:Cardiology / Q000592:standards*; D004562:Electrocardiography / Q000592:standards*; D004632:Emergency Medical Services / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D014481:United States