Successful collaborative model for STEMI care between a STEMI-referral and a STEMI receiving center.

ABSTRACT

BACKGROUND: Patients with ST-segment elevation myocardial infarction (STEMI) greatly benefit from a rapid door-to-balloon (D2B) time. For hospitals without a catheterization laboratory, it is imperative to establish partnerships with a STEMI receiving center (SRC). STEMI systems of care have been established to facilitate these relationships to improve rapid reperfusion. We describe the experience and benefits of such a relationship. METHODS: A partnership between our 2 institutions was established in April 2011. Saint Anthony Hospital (SAH) of Chicago is an inner city hospital with interventional cardiologists on staff, but no catheterization laboratory. Before the partnership, STEMI patients were transferred 8 miles to a percutaneous coronary intervention (PCI) hospital on the city's north side. Rush University Medical Center (RUMC) is an academic medical center with 24/7/365 PCI capability. SAH decided that a transfer relationship with a closer SRC would benefit patient care. The following steps were taken both hospitals signed a STEMI transfer agreement for STEMI transfers regardless of insurance status; an education process occurred at both hospitals; agreement that transferred patients would follow-up at the STEMI referring hospital (SAH); a contract with a single ambulance provider was signed; a simple STEMI protocol was adopted. RESULTS: In 2010, SAH saw 20 patients with STEMI. Average time from patient arrival to leaving the emergency department (ED) [Door-in-Door-out (DIDO)] was 83 minutes, these times were not tracked carefully; approximate transfer time to SRC was 25 minutes; Door1-2-Balloon (D12B) time was not recorded. Since the new protocol, 44 patients transferred to RUMC for PCI to date. Median (inclusive minimum, maximum) time from ED arrival (D1) at referral hospital to SRC (D2) was 52 minutes (56, 192) for all PCI cases; 11 patients transferred did not have PCI; 1 patient expired upon arrival; and median time to first PCI device (D12B) was 86 minutes (53-167). DISCUSSION: Streamlining STEMI patient care to reduce D2B is a major priority. We have demonstrated that establishing a transfer program between a STEMI-Referral Hospital (SRH) and SRC can markedly improve time to reperfusion. This approach has resulted in D12B that match or exceeds the D2B for nontransfer patients at most STEMI-receiving hospitals.