Primary percutaneous coronary intervention for patients presenting with ST-segment elevation myocardial infarction: process improvement in a rural ST-segment elevation myocardial infarction receiving center.
BACKGROUND
Rural ST-segment elevation myocardial infarction (STEMI) care networks may be particularly disadvantaged in achieving a door-to-balloon time (D2B) of less than or equal to 90 minutes recommended in current guidelines. ST-ELEVATION MYOCARDIAL INFARCTION PROCESS UPGRADE PROJECT: A multidisciplinary STEMI process upgrade group at a rural percutaneous coronary intervention center implemented evidence-based strategies to reduce time to electrocardiogram (ECG) and D2B, including catheterization laboratory activation triggered by either a prehospital ECG demonstrating STEMI or an emergency department physician diagnosing STEMI, single-call catheterization laboratory activation, catheterization laboratory response time less than or equal to 30 minutes, and prompt data feedback.
An ongoing regional STEMI registry was used to collect process time intervals, including time to ECG and D2B, in a consecutive series of STEMI patients presenting before (group 1) and after (group 2) strategy implementation. Significant reductions in time to first ECG in the emergency department and D2B were seen in group 2 compared with group 1.


CONCLUSIONS
Important improvement in the process of acute STEMI patient care was accomplished in the rural percutaneous coronary intervention center setting by implementing evidence-based strategies.
Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.nat.niles@hitchcock.org
Nathaniel W
NW
Niles
Sheila M
SM
Conley
Rayson C
RC
Yang
Pantila
P
Vanichakarn
Tamara A
TA
Anderson
John R
JR
Butterly
John F
JF
Robb
John E
JE
Jayne
Norman N
NN
Yanofsky
Jean A
JA
Proehl
Donald F
DF
Guadagni
Jeremiah R
JR
Brown
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000458:organization & administration; D019317:Evidence-Based Medicine; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009513:New Hampshire; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation; D011446:Prospective Studies; D011787:Quality of Health Care / Q000458:organization & administration*; D012040:Regional Health Planning / Q000458:organization & administration; D012042:Registries; D019035:Rural Health Services / Q000458:organization & administration*; D013997:Time Factors; D014187:Transportation of Patients / Q000458:organization & administration; D016896:Treatment Outcome