Cardiovascular Disease

SESSION TITLE: Cardiovascular 2

SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM

Implementing an Inpatient Protocol: Improving Time to Treatment for STEMIs

Erika Leung Ryan Medas* Mary Randazzo Tinashe Maduke Onyema Nnanna and Morton Rinder St Luke’s Hospital,
Chesterfield, MO

PURPOSE: Recent studies suggest a higher mortality for inpatient STEMIs compared to STEMI patients who arrive in the
emergency department (ED) or are transferred from an outside facility. The question of how to improve outcomes and definition
of optimum treatment in hospitalized patients experiencing a STEMI merits greater concern and attention across the nation. Part
of the increased mortality can be due to less timely reperfusion as a result of unfamiliar personnel on non-cardiac floors. St Luke’s
Hospital, a community hospital in suburban Missouri, recently instituted a protocol for inpatient STEMIs in order to decrease
time to reperfusion. The focus was to give non-cardiology personnel the appropriate guidance to facilitate reperfusion similar to
the ED protocol. This analysis of recent inpatient STEMIs was done to identify gaps and barriers to prompt treatment; including
difficulty in identifying symptoms, interpreting ECGs, as well as long delays in decision making.
METHODS: For the last ten years there has been a protocol in place at our hospital for STEMI patients that come through the ED
in association with national door-to-balloon time (D2B) initiatives. The goal is to apply a similar protocol to inpatients already in
the hospital. We instituted a protocol for treatment of inpatients STEMIs according to the current standards of care established by
the American College of Cardiology. This protocol includes four steps that need to be followed to implement timely treatment: 1)
identify a STEMI on an ECG, 2) have the ECG over-read by a qualified physician, 3) activate the STEMI team, and 4) have the
CARDIOVASCULAR DISEASE

care handed off to the STEMI team of cardiac catheterization laboratory nurses and the interventional cardiologist on call. We
defined the initial time as the time that the ECG was performed; a “door” time was deemed inappropriate and any other measure
was too ambiguous.
RESULTS: Prior to initiating the protocol, there were 8 inpatient STEMI patients; and 7 inpatient STEMI patients after the
protocol implementation. The average time to reperfusion for patients prior to the change was 406 minutes. The average time to
reperfusion for patients after the protocol rollout was 68 minutes. A significant improvement was achieved with time to
reperfusion defined as time of the initial ECG to balloon or device intervention after implementation of the inpatient STEMI
protocol (p<0.05).
CONCLUSIONS: In a community hospital, it is feasible and necessary to implement a protocol for inpatient STEMI management
which will greatly improve the time to appropriate treatment. Some areas identified for improvement include false activations,
following a protocol on non-cardiac floors, and stricter definition of time-to-treatment, as this was difficult to determine since the
patient did not have “door” time but rather, a symptom that prompted an ECG.
CLINICAL IMPLICATIONS: It is possible and necessary to implement a protocol for inpatient STEMI management to improve
time to appropriate treatment in a community hospital; however there are still areas identified for further research.
DISCLOSURE: The following authors have nothing to disclose: Erika Leung, Ryan Medas, Mary Randazzo, Tinashe Maduke,
Onyema Nnanna, Morton Rinder
No Product/Research Disclosure Information
DOI: http://dx.doi.org/10.1016/j.chest.2017.08.100
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

70A [ 152#4S CHEST OCTOBER 2017 ]