Abstract 159: Achieving STEMI Revascularization Goals with an Inter-Hospital Transfer System

Background: Primary PCI has been recognized as the procedure of choice for STEMI revascularization when performed in a timely manner. Developing an effective system to allow immediate transfers from non-PCI capable community hospitals to a PCI capable center requires continued collaborative effort to achieve and maintain. Stony Brook University Hospital (UH) is the sole tertiary care hospital in Suffolk county (population of 1.5 million; area over 900 square miles). Particularly challenging for effective revascularization is the lack of a triage strategy permitting direct transfer to PCI capable hospitals and the system of multiple voluntary EMS providers. Post C Port trials, additional sites capable of performing PCI have opened, but for much of the county UH remains the center of choice. For hospitals with a transport time of over 45 minutes lytic therapy is typically advised as the primary reperfusion strategy. We report our efforts at improving D2B times to achieve a first medical contact (FMC) to device time of < 120 minutes for our most challenging referral hospital (20 miles away with a one way travel time of 25-40 minutes). Methods: The 2011 FMC -to balloon (2B) time of transfers was compared to the FMC-2B median times in 2012 after a series of system based changes were initiated. Efforts focused on early performance and interpretation of an ECG in appropriate patients, immediate transport to UH for revascularization, activation of the UH cath lab simultaneous with transport. Results: FMC-2B times improved from a median time of 145.0 minutes in 2011 to 118.5 minutes in 2012. With the early activation of the UH cath lab the SB D2B time was consistently < 30 minutes, allowing up to 90 minutes for the identification and transfer of the STEMI patient. Transport time remained the greatest variable and caused the most outliers, while improvement opportunities in performance of ECG, ECG interpretation and team activation were also identified. Immediate feedback and monthly review of cases facilitated process improvement. Conclusions: Improving FMC-D2B times in a system with referring non-PCI capable hospitals is challenging and requires efforts to establish protocols aimed at promoting a regional system of STEMI care. Assigning interval responsibility, shared participation in identifying opportunities for improvement, immediate feedback, periodic review by all team participants can effectively move the process forward.