학술논문
Abstract 18760: Door to Door to Balloon Times Significantly Reduced in a Frontier State System of Care Project
Document Type
Academic Journal
Author
Hope, Joani; Cahill, Amanda; Kane, Bobbie; McNamara, Michael; Oser, Carrie; Fogle, Crystelle; Fogle, Crystelle; Scandelson, Scott; Spoon, Daniel B; Lowe, Eric; Hall, Nathaniel; Vandenberg, James; Kitowski, Sloane; Fenton, Sarah; Swart, Tami; Mohr, Todd; Stroot, Sandra; Maley, Thomas; Arcangel, Rea Anne; Waldo, Douglas
Source
Circulation. Nov 14, 2017 136(Suppl_1 Suppl 1):A18760-A18760
Subject
Language
English
ISSN
0009-7322
Abstract
Introduction: In 2014, a statewide workgroup “Mission: Lifeline Montana” was created to address the challenges of timely ST elevation myocardial infarction (STEMI) care in Montana. The goal of Mission: Lifeline Montana was to build a system of care for STEMI to decrease mortality and improve outcomes. Due to the geographic size of Montana (MT), coupled with the limited number of percutaneous intervention (PCI) centers, almost 40% of MT’s STEMI patients are transfer patients, compared to 25% nationally.Hypothesis: It was hypothesized that a statewide initiative would improve door-to-door-to-balloon time (D2D2B) in transfer patients, a key performance metric.Methods: The group focused on developing statewide acute order-sets, public education campaigns, as well as, regional and statewide trainings targeting both emergency medical services (EMS) and hospital personnel. In addition, MT received grant funding to equip EMS with 12 lead electrocardiogram (ECG) transmission units. The ACTION Registry® GWTG™ was used as a data source since 8 of MT’s 9 PCI hospitals were using it. These 8 PCI centers have the highest volume of STEMI patients in MT. Baseline data collection began in January 2015 using rolling 12-month data. To assess D2D2B in transfer patients, the median time to treatment and the percent of transfer patients receiving primary PCI within 90 and 120 minutes were used.Results: At baseline, the median time from arrival at the referral hospital to primary PCI for transfer patients (n=181) was 155 minutes with no transfer patients achieving D2D2B within 90 minutes and only 14% were treated within 120 minutes. By Quarter 4, 2016 (n=229), the median time to treatment decreased to 122 minutes (20% improvement) and also exceeds the national median aggregate time of 136 minutes. In addition, improvements in the percent of transfer patients treated within 90 minutes (10%) and 120 minutes (50%) were also noted and exceeds the national median aggregate of 5% and 32%, respectively.Conclusions: Implementing a system of care which included extensive educational efforts targeting the general public, EMS and hospital systems as well as equiping the majority of MT’s EMS with 12 lead ECG transmission units had a significant impact on D2D2B times for transfer STEMI patients.