Activation of the Cardiac Catheterization Lab for STEMI Patients

A Reduction in D2B Time

Our baseline D2B time prior to the intervention was 52.5 minutes. After our intervention, average D2B times for 2012, 2013, 2014, and 2015 were 38.2, 33.5, 39, and 37.25 minutes, respectively. The institution’s baseline rate of unnecessary activation prior to intervention in 2011 was 19.1%. After intervention, the EMS unnecessary activation rates for 2012, 2013, 2014, and 2015 were 30%, 18%, 15%, and 19% respectively, averaging 20.5% over 4 years, or 17.3% for 2013 through 2015.

Emergency medical services averaged approximately 164 STEMI activations each year. We decreased D2B times for patients by over 15 minutes from 2011 compared to 2012 through 2015. These results were sustained, with attention to metrics, over four years. Furthermore, the proportion of STEMI patients receiving immediate PCI within the recommended 90 minutes was 100% of patients in 2014 and 2015, reflecting consistent improvement over 2012 and 2013.

We also demonstrated an overall reduction in the unnecessary CCL activation rate by EMS over the time of our intervention. Our analysis of unnecessary activation causes and EMS education led to improvement in the unnecessary activation rate from 2012-2015, and these rates have been sustained over time. The rate of unnecessary activation by EMS in 2012 to 2015 was 20.5%.

Conclusion

Lower D2B time for STEMI patients is associated with lower mortality following PCI for patients with acute MI, fewer complications, and shorter length of stay in the hospital. We successfully lowered D2B time after empowering EMS to activate our interventional cardiology laboratory prior to arrival at the hospital for patients with acute STEMI, coupled with the ability to bypass the ED for patients with acute STEMI presentations. With rigorous attention to metrics and ongoing aggressive medic education, we were able to achieve consistent, sustained D2B times under 40 minutes over the course of four consecutive years. We present our experience as a potential model of a multifaceted intervention for other systems to consider replicating.