Sharing and Teaching Electrocardiograms to Minimize Infarction (STEMI): reducing diagnostic time for acute coronary occlusion in the emergency department

McLaren, Jesse T.T.; Taher, Ahmed; Kapoor, Monika; Yi, Soojin L.; Chartier, Lucas B.

doi:10.1016/j.ajem.2021.03.067

Cited by 6 publications

(5 citation statements)

References 60 publications

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“…ECG-to-Activation time reflects the diagnostic time of emergency physicians, is independent of cath lab capabilities, and can be compared across different settings; this metric can help identify preventable reperfusion delays and promote new advances in ECG interpretation [ 12 ]. In our QI project, including a grand rounds presentation based on the article by Miranda et al, followed by weekly ECG audit and feedback to all physicians on signs of OMI, ECG-to-Activation time was reduced by 20 min [ 13 ].…”

Section: Omi Paradigm and Qimentioning

confidence: 99%

From STEMI to occlusion MI: paradigm shift and ED quality improvement

et al. 2021

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A generation ago the ST-elevation myocardial infarction (STEMI) paradigm led to quality improvement (QI) in the emergency department (ED). Now, insights from angiography and advances in electrocardiogram (ECG) interpretation have led to the new paradigm of occlusion myocardial infarction (OMI), creating the possibility of further QI. This article reviews the current STEMI paradigm, the emergence of the OMI paradigm, and the use of QI to continuously improve care for acute myocardial infarction (AMI) patients in the ED.

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Section: Omi Paradigm and Qimentioning

confidence: 99%

From STEMI to occlusion MI: paradigm shift and ED quality improvement

et al. 2021

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“…DTE time has been widely studied and DTE time ≤ 10 min is considered a key quality metric for triage nurses [ 39 ]. We previously demonstrated that the ETA time is another important quality metric, specific to emergency physicians [ 40 ], and that it can help guide quality improvement initiatives to reduce diagnostic time for acute coronary occlusion [ 41 ]. Together, DTE and ETA times form the Door-to-Activation (DTA) time, which is a key driver of DTB time: achieving a DTA time of ≤20 min has been associated with a DTB time of ≤90 min, a widely accepted measure of STEMI quality [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Flattening the other curve: Reducing emergency department STEMI delays during the COVID-19 pandemic

McLaren¹,

Taher²,

Chartier³

2021

The American Journal of Emergency Medicine

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Background The COVID-19 pandemic has been associated with ST-Elevation Myocardial Infarction (STEMI) reperfusion delays despite reduced emergency department (ED) volumes. However, little is known about ED contributions to these delays. We sought to measure STEMI delays and ED quality benchmarks over the course of the first two waves of the pandemic. Study This study was a multi-centre, retrospective chart review from two urban, academic medical centres. We obtained ED volumes, COVID-19 tests and COVID-19 cases from the hospital databases and ED Code STEMIs with culprit lesions from the cath lab. We measured door-to-ECG (DTE) time and ECG-to-Activation (ETA) time during the phases of the pandemic in our jurisdiction: pre-first wave (Jan-Mar 2020), first wave (Apr-June 2020), post-first wave (July-Nov 2020), and second wave (Dec 2020 to Feb 2021). We calculated median DTE and ETA times and compared them to the 2019 baseline using Wilcox rank-sum test. We calculated the percentages of DTE ≤10 min and of ETA ≤10 min and compared them to baseline using chi-square test. We also utilized Statistical Process Control (SPC) Xbar-R charts to assess for special cause variation. Results COVID-19 cases began during the pre-wave phase, but there was no change in ED volumes or STEMI quality metrics. During the first wave ED volumes fell by 40%, DTE tripled (10.0 to 29.5 min, p = 0.016), ETA doubled (8.5 to 17.0 min, p = 0.04), and percentages for both DTE ≤10 min and ETA ≤10 min fell by three-quarters (each from more than 50%, to both 12.5%, both p < 0.05). After the first wave all STEMI quality benchmarks returned to baseline and did not significantly change during the second wave. A brief period of special cause variation was noted for DTE during the first wave. Conclusions Both DTE and ETA metrics worsened during the first wave of the pandemic, revealing how it negatively impacted the triage and diagnosis of STEMI patients. But these normalized after the first wave and were unaffected by the second wave, indicating that nurses and physicians adapted to the pandemic to maintain STEMI quality of care. DTE and ETA metrics can help EDs identify delays to reperfusion during the pandemic and beyond.

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“…In a collection of falsely normal cases, 9 the majority were interpreted by the Veritas algorithm. While the risks of computer‐labeled normal ECGs are likely generalizable to any ED using conventional algorithm, the benefits of physician review are less generalizable because our two centers have received audit/feedback on advanced ECG interpretation since 2019 11 . Future studies can look at all patients with OMI, from both STEMI and non‐STEMI databases, and can use emerging automated intelligence interpretation to identify normal ECGs diagnostic of OMI, which would be generalizable beyond centers with ECG audit/feedback.…”

Section: Patient Computer Interpretation Blinded Cardiologist Interpr...mentioning

confidence: 99%

Emergency department Code STEMI patients with initial electrocardiogram labeled “normal” by computer interpretation: A 7‐year retrospective review

McLaren,

Meyers,

Smith

et al. 2023

Academic Emergency Medicine

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Sharing and Teaching Electrocardiograms to Minimize Infarction (STEMI): reducing diagnostic time for acute coronary occlusion in the emergency department

Cited by 6 publications

References 60 publications

From STEMI to occlusion MI: paradigm shift and ED quality improvement

From STEMI to occlusion MI: paradigm shift and ED quality improvement

Flattening the other curve: Reducing emergency department STEMI delays during the COVID-19 pandemic

Emergency department Code STEMI patients with initial electrocardiogram labeled “normal” by computer interpretation: A 7‐year retrospective review

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