“Call 911” STEMI Protocol to Reduce Delays in Transfer of Patients From Non Primary Percutaneous Coronary Intervention Referral Centers

Baruch, Terrence; Rock, Alisa; Koenig, William; Rokos, Ivan C.; French, William J.

doi:10.1097/hpc.0b013e3181e9d410

Cited by 10 publications

(10 citation statements)

References 13 publications

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“…This adds to the prior single‐center pilot study that demonstrated a reduction in median FMC2B by 50%, from 167.5 to 88.5 minutes after implementation of the Call 911 protocol 19. Similarly, Tennyson et al 27 evaluated the use of the municipal 911 ALS ambulance service compared with a contracted private ambulance service for STEMI IFTs from a single community hospital to a tertiary care center.…”

Section: Discussionmentioning

confidence: 95%

“…A prior pilot study at a single PCI-capable center within the Los Angeles (LA) County regional cardiac system demonstrated the use of 911 for interfacility STEMI transfers to be both safe and feasible, resulting in a 50% reduction in median FMC2B time. 19 In the current study, we evaluated the FMC2B time for patients with STEMI after implementation of a "Call 911" protocol for STEMI IFTs across the entire regional system.…”

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confidence: 99%

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Regional “Call 911” Emergency Department Protocol to Reduce Interfacility Transfer Delay for Patients With ST‐Segment–Elevation Myocardial Infarction

Bosson

Baruch

French

et al. 2017

JAHA

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BackgroundWe evaluated the first‐medical‐contact‐to‐balloon (FMC2B) time after implementation of a “Call 911” protocol for ST‐segment–elevation myocardial infarction (STEMI) interfacility transfers in a regional system.Methods and ResultsThis is a retrospective cohort study of consecutive patients with STEMI requiring interfacility transfer from a STEMI referring hospital, to one of 35 percutaneous coronary intervention‐capable STEMI receiving centers (SRCs). The Call 911 protocol allows the referring physician to activate 911 to transport a patient with STEMI to the nearest SRC for primary percutaneous coronary intervention. Patients with interfacility transfers were identified over a 4‐year period (2011–2014) from a registry to which SRCs report treatment and outcomes for all patients with STEMI transported via 911. The primary outcomes were median FMC2B time and the proportion of patients achieving the 120‐minute goal. FMC2B for primary 911 transports were calculated to serve as a system reference. There were 2471 patients with STEMI transferred to SRCs by 911 transport during the study period, of whom 1942 (79%) had emergent coronary angiography and 1410 (73%) received percutaneous coronary intervention. The median age was 61 years (interquartile range [IQR] 52–71) and 73% were men. The median FMC2B time was 111 minutes (IQR 88–153) with 56% of patients meeting the 120‐minute goal. The median STEMI referring hospital door‐in‐door‐out time was 53 minutes (IQR 37–89), emergency medical services transport time was 9 minutes (IQR 7–12), and SRC door‐to‐balloon time was 44 minutes (IQR 32–60). For primary 911 patients (N=4827), the median FMC2B time was 81 minutes (IQR 67–97).ConclusionsUsing a Call 911 protocol in this regional cardiac care system, patients with STEMI requiring interfacility transfers had a median FMC2B time of 111 minutes, with 56% meeting the 120‐minute goal.

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Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Regional “Call 911” Emergency Department Protocol to Reduce Interfacility Transfer Delay for Patients With ST‐Segment–Elevation Myocardial Infarction

Bosson

Baruch

French

et al. 2017

JAHA

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“…Multiple strategies hold promise. For example, activating EMS transportation prior to PCI center activation, 24 using the 911 system to transfer patients, 25 using operations research tools to enhance the operational flexibility of the ED, 26,27 enhancing regionalization efforts to reduce EMS response times, 28,29 standardizing the initial interaction with EMS (eg, patient staying on the stretcher), 24 enhancing hospital-EMS relationships, 22 and appropriate use of ground-based (rather than helicopter) EMS. 19,20 …”

Section: Discussionmentioning

confidence: 99%

Timeliness of interfacility transfer for ED patients with ST-elevation myocardial infarction

Ward

Kripalani

Storrow

et al. 2015

The American Journal of Emergency Medicine

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Objectives Most U.S. hospitals lack primary percutaneous coronary intervention (PCI) capabilities to treat patients with ST-elevation myocardial infarction (STEMI) necessitating transfer to PCI-capable centers. Transferred patients rarely meet the 120-minute benchmark for timely reperfusion and referring EDs are a major source of preventable delays. We sought to use more granular data at transferring EDs to describe the variability in length of stay at referring EDs. Methods We retrospectively analyzed a secondary dataset used for quality improvement for patients with STEMI transferred to a single PCI center between 2008 and 2012. We conducted a descriptive analysis of the total time spent at each referring ED (door-in-door-out [DIDO] interval), time periods that comprised DIDO (door-to-EKG, EKG-to-PCI activation, and PCI activation-to-exit), and the relationship of each period with overall time to reperfusion (medical contact-to-balloon [MCTB] interval). Results We identified 41 EDs that transferred 620 patients between 2008 and 2012. Median MCTB was 135 minutes (IQR 114,172). Median overall ED DIDO was 74 minutes (IQR 56,103) and was comprised of: door-to-EKG 5 minutes (IQR 2,11), EKG-to-PCI activation 18 minutes (IQR 7,37), and PCI activation-to-exit 44 minutes (IQR 34,56). DIDO accounted for the largest proportion (60%) of overall MCTB and had the largest variability (coefficient of variability=1.37) of these intervals. Conclusions In this cohort of transferring EDs, we found high variability and substantial delays after EKG performance for patients with STEMI. Factors influencing ED decision-making and transportation coordination following PCI activation are a potential target for intervention to improve the timeliness of reperfusion in patients with STEMI.

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“…In Turkey, to date, no investigations into the medical transport-chain and transport durations have been conducted. In addition, it was recently reported that the development of city-wide transport protocols and the establishment of hospital networks could shorten pain-to-balloon time in some countries (25)(26)(27)(28)(29)(30). In contrast, in Turkey, no transport-chain protocol has been proposed by the municipality or health ministry.…”

Section: Discussionmentioning

confidence: 99%

Impact of emergency services and ambulance type on pain-to-balloon time in the acute myocardial infarction: an observational study

Karabulut¹,

Cakmak²,

Uzunlar³

et al. 2012

Anadolu Kardiyol Derg

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Objective: The objective of this study was to evaluate the role of first contact emergency departments and ambulances on transport duration, pain-to-balloon time, door-to-balloon time and first contact-to-balloon time in acute myocardial infarction (AMI) patients. Methods: The study was a prospective and observational investigation. A total of 374 AMI patients initially admitted to primary coronary intervention (PCI) incapable centers were included in this study. Patients were classified according to initial presentation site (daily clinic, public hospital or private hospital) and transport manner (public or private ambulance). All groups were compared by the Kruskal-Wallis and MannWhitney U tests statistically according to their characteristics, transport duration and pain-to-balloon time.Results: A majority of the patients were initially admitted to public (40.1%) or private hospitals (47.1%). The average door-to-balloon time was 45.0±18.5 min and the mean pain-to-balloon time was 310.6±160.8 min. Nearly half of the patients initially admitted to daily clinics were first transported to PCI-incapable centers, leading to delayed admission to PCI-capable centers and increased pain-to-balloon and first contact-toballoon times (361.7±194.5 min, p=0.01 and 279.7±158.2 min, p<0.001). Patients admitted to private hospitals experienced shorter average painto-balloon and first contact-to-balloon times (277.5±148.6 min, p=0.01 and 157.4±83.1 min, p<0.001). Patients transported by private ambulances also experienced shorter waiting times and shorter pain-to-balloon times (107.4±70.4 and 270.1±150.4 min, p<0.001). Conclusion: Physicians and healthcare professionals in first contact emergency departments and ambulance type appear to be factors in the increased pain-to-balloon time. AMI patients are often initially admitted to PCI-incapable centers, leading to delayed admission to PCI-capable centers and increased pain-to-balloon time. (Anadolu Kardiyol Derg 2012; 12: 23-9) Key words: Emergency services, ambulance, pain-to-balloon time 23ÖZET Amaç: Bu çalışma ileriye dönük gözlemsel bir araştırma olup; akut miyokart enfarktüslü (AME) hastalarında, ilk başvurulan acil servis ile ambulans tipinin hasta nakil süresi, ağrı-balon zamanı, kapı-balon süresi ve ilk kontak-balon süresi üzerindeki etkilerini araştırmayı amaçladık. Yöntemler: İlk olarak primer koroner girişim (PKG) imkânı olmayan hastanelere başvuran toplam 374 AMI hastası çalışmaya dâhil edildi. Hastalar ilk başvurdukları merkezlere göre; günlük klinik-tıp merkezi, devlet hastanesi ve özel hastane grubu olarak sınıflandırıldı. Hastalar aynı zamanda nakil sırasında kullanılan ambulans tipine göre de 112 ambulansı veya özel ambulans olarak iki grupta sınıflandırıldı. Tüm gruplar Kruskal-Wallis ve Mann-Whitney U testleri ile istatistiksel olarak demografik özellikler, nakil süresi ve ağrı-balon zamanına göre karşılaştırıldı. Bulgular: Hastaların çoğunluğu ilk olarak devlet hastanesi veya özel hastaneye başvurmuştu (40.1% ve 47.1%). Ortalama kapı-balon süresi 45.0...

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“Call 911” STEMI Protocol to Reduce Delays in Transfer of Patients From Non Primary Percutaneous Coronary Intervention Referral Centers

Cited by 10 publications

References 13 publications

Regional “Call 911” Emergency Department Protocol to Reduce Interfacility Transfer Delay for Patients With ST‐Segment–Elevation Myocardial Infarction

Regional “Call 911” Emergency Department Protocol to Reduce Interfacility Transfer Delay for Patients With ST‐Segment–Elevation Myocardial Infarction

Timeliness of interfacility transfer for ED patients with ST-elevation myocardial infarction

Impact of emergency services and ambulance type on pain-to-balloon time in the acute myocardial infarction: an observational study

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