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 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.
What are some common perceptions other parties within the STEMI system of care may have regarding STEMI-receiving hospitals that must be overcome in order to build more cohesive partnerships? Emergency medical service (EMS) providers and
STEMI-referring hospitals that treat patients who are then transferred to a STEMI-receiving hospital 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 STEMI-referring hospitals play in the treatment of STEMI patients, the PCI centers must close this communication gap.
Furthermore, STEMI-referring hospitals may feel that diverting or transferring STEMI patients to PCI-capable hospitals will result in substantial lost revenue. While STEMI victims make up the minority of heart attack patients, this perceived
economic threat to non-PCI hospitals must be addressed.
What are some of the progress markers for STEMI-receiving hospitals as they seek to improve their contribution to the STEMI system of care? Mission: Lifeline has defined progress markers for three key areas related to PCI-capable centers,
as shown in the table below.
Median (25th, 75th) arrival time for interventional cardiologist and staff at lab
Percentage of PCI hospitals that have predefined STEMI protocols (perhaps too low a bar)
Percentage of hospitals that have implemented a predefined management plan for emergency coronary bypass surgery (+/-)
Percent of patients eligible for reperfusion who receive it
Percent of patients receiving reperfusion who meet American Heart Association / American College of Cardiology median (25th, 75th) door-to-balloon time
Percent of eligible patients that receive door-to-balloon time of 90 minutes or less or door-to-needle time of 30 minutes or less
Median (25th, 75th) door-to-balloon time and door-to-balloon 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 patient ischemic time overall and stratified by transfer status
Proportion of eligible STEMI (or overall MI) patients administered guideline-based class I therapies
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 CBG during admission
What are the progress markers for emergency departments (EDs) as they seek to improve their contribution to the STEMI system of care? Mission: Lifeline has defined progress markers for three key areas related to emergency departments, as
shown in the table below.
Adequate staff, equipment and training to perform emergency department rapid evaluation, triage and treatment
Presence of a single, standardized STEMI care pathway
Presence of a one-contact STEMI hotline
Door to first ECG time
Proportion of STEMI-eligible patients receiving any reperfusion
Door-to-catheterization-laboratory time or door-to-disposition time
Proportion of patients ineligible for lytics but eligible for PCI