Click a question for the answer.

1. How does Mission: Lifeline respond to the varied interests of competing hospitals and cardiology groups, multiple EMS providers, and access and control of critical care transport or helicopters regarding the STEMI and/or cardiac resuscitation plan?

Realizing that all of these entities come to the table with their own agendas, priorities and concerns, Mission: Lifeline seeks to build a consensus around what is best for the patient according to data, guidelines, resources and local leadership.

2. What are some common perceptions other parties have regarding receiving centers that must be overcome in order to build more cohesive partnerships?

Emergency medical service (EMS) providers and referral centers that initially treat patients prior to transferring to a receiving center often face a "black hole" experience. Once the patient is out of their care, they are left with questions about outcomes and whether their contributions to treatment helped achieve success. To improve quality of care and recognize the contribution that EMS and referral centers play in the treatment of STEMI and/or cardiac resuscitation patients, the receiving (PCI-capable) centers must close this communication gap.

Furthermore, referral centers may feel that diverting or transferring STEMI and/or cardiac resuscitation patients to receiving hospitals will result in substantial lost revenue. While STEMI victims make up the minority of heart attack patients, this perceived economic threat to referral hospitals must be addressed.

3. What are some of the progress markers for receiving centers as they seek to improve their contribution to the STEMI and/or cardiac resuscitation system of care?

Mission: Lifeline has defined progress markers for three key areas related to receiving centers, as shown in the table below.

PROGRESS MARKERS
Structure	Median (25th, 75th) arrival time for interventional cardiologist and staff at lab Percentage of PCI hospitals that have predefined STEMI / cardiac resuscitation protocols (perhaps too low a bar) Percentage of hospitals that have implemented a predefined management plan for emergency coronary bypass surgery (+/-)
Process	Percent of patients eligible for reperfusion who receive it Percent of patients receiving reperfusion who meet the American Heart Association / American College of Cardiology median (25th, 75th) recommended door-to-reperfusion time Percent of eligible patients that receive door-to- reperfusion time of 90 minutes or less or door-to-needle time of 30 minutes or less Median (25th, 75th) door-to- reperfusion n time and door-to- reperfusion time of less than 90 minutes as well as median (25th, 75th) door-to-needle time and door-to-needle time of less than 30 minutes for transfer patients Median (25th, 75th) times for overall patient ischemic time overall and stratified by transfer status Proportion of eligible patients administered guideline-based class I therapies
Outcomes	Incidence of vascular complications Angiographic success: Percent of stented lesions with angiographic success Procedure success: Percent of procedures with angiographic success and no death, MI or emergent/salvage CABG during admission In-hospital mortality, 30-day risk-adjusted mortality

4. What are the progress markers for emergency departments (EDs) as they seek to improve their contribution to the system of care?

Mission: Lifeline has defined progress markers for three key areas related to emergency departments, as shown in the table below.

PROGRESS MARKERS
Structure	Adequate staff, equipment and training to perform emergency department rapid evaluation, triage and treatment for any cardiac emergency Presence of a single, standardized STEMI / cardiac resuscitation care pathway Presence of a one-contact STEMI / cardiac resuscitation hotline
Process	Door to first ECG time Proportion of eligible patients receiving any reperfusion Door-to-catheterization-laboratory time or door-to-disposition time Proportion of patients ineligible for fibrinolytics but eligible for PCI