Achieving Health System Wide 90 Minute Door-to-balloon Times for STEMI Transfers

Introduction Most patients experiencing STEMI present to facilities that lack interventional cardiology services, thus requiring transport to a tertiary center. The national D2B goal time for patients requiring interfacility transfer is 120 minutes or less; our previous work achieved that goal by implementing an STEMI autolaunch process. To further improve D2B times for transfer patients we took a systems level approach to develop a high reliability STEMI transfer system. The primary interventions, system changes, and results are presented. Methods This was a quality improvement project that entailed a collaboration between the Emergency Services Institute, Heart and Vascular Institute, Critical Care Transport, health system community hospitals and local emergency medical services throughout our region. Over 18 months, system changes were developed by the interdisciplinary team (Table 1), implemented, and evaluated with feedback provided to all involved on a monthly basis. Results Patients presenting to community hospital ED's experienced a 16 minute reduction in door-in-door-out time (now 44 minutes versus 60 minutes). Additionally the mean D2B times for all patients requiring transfer in the health system reduced to and remained at 90 minutes for 12 consecutive months in 2017. Reported mortality at the project start was below the 50th percentile and now exceeds the 90th percentile nationally. Conclusion Our results show that improving and maintaining D2B times for patients needing interfacility transfer requires a systems level approach that must encompass the entire healthcare system from initial patient activation through to discharge. The interventions developed can be adapted and applied in other settings.