Improving use of prehospital 12-lead ECG for early identification and treatment of acute coronary syndrome and ST-elevation myocardial infarction.
BACKGROUND
Performance of prehospital ECGs expedites identification of ST-elevation myocardial infarction and reduces door-to-balloon times for patients receiving reperfusion therapy. To fully realize this benefit, emergency medical service performance must be measured and used in feedback reporting and quality improvement.


RESULTS
This quasi-experimental design trial tested an approach to improving emergency medical service prehospital ECGs using feedback reporting and quality improvement interventions in 2 cities' emergency medical service agencies and receiving hospitals. All patients age > or =30 years, calling 9-1-1 with possible acute coronary syndrome, were included. In total, 6994 patients were included: 1589 patients in the baseline period without feedback and 5405 in the intervention period when there were feedback reports and quality improvement interventions. Mean age was 66+/-17 years, and women represented 51%. Feedback and quality improvement increased prehospital ECG performance for patients with acute coronary syndrome from 76% to 93% (P=<0.0001) and for patients with ST-elevation myocardial infarction from 77% to 99% (P=<0.0001). Aspirin administration increased from 75% to 82% (P=0.001), but the median total emergency medical service run time remained the same at 22 minutes. The proportion of patients with door-to-balloon times of < or =90 minutes increased from 27% to 67% (P=0.006).


CONCLUSIONS
Feedback reports and quality improvement improved prehospital ECG performance for patients with acute coronary syndrome and ST-elevation myocardial infarction and increased aspirin administration without prehospital transport delays. Improvements in door-to-balloon times were also seen.
Daudelin
Denise H
DH
Center for Cardiovascular Health Services Research, Tufts Medical Center, Boston, MA, USA.
Sayah
Assaad J
AJ
Kwong
Manlik
M
Restuccia
Marc C
MC
Porcaro
William A
WA
Ruthazer
Robin
R
Goetz
Jessica D
JD
Lane
William M
WM
Beshansky
Joni R
JR
Selker
Harry P
HP
D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use; D042241:Early Diagnosis; D004562:Electrocardiography / Q000706:statistics & numerical data*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D015425:Myocardial Reperfusion; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care
D001241:Aspirin