Transportation of ST-segment elevated myocardial infarctions in rural Montana to percutaneous coronary intervention capable medical centers and achievement of goal treatment times

Abstract

Background: Rapid reperfusion via primary percutaneous coronary intervention or thrombolytic therapy is critical to limit death and disability associated with ST-elevated myocardial infarction. However, the majority of Montanans reside in rural areas and require time consuming interfacility transportation for specialized cardiac care. Purpose: The aim of this scholarly project is to analyze the treatment and transfer process of adult patients experiencing a ST-elevated myocardial infarction with initial presentation to a rural medical facility requiring interfacility transfer for specialized cardiac care to generate quality improvement recommendations for changes in the care and transfer process to decrease door-to-needle, door-to-door, and door-to-balloon times among this patient population. Sample: Subjects were adults (18 years of age and older) diagnosed with a ST-elevated myocardial infarction at a rural medical facility and transferred to the nearest STEMI receiving medical facility for specialized cardiac services. Subjects transferred for primary PCI and post thrombolytic therapy were included in this project (n = 8). Methods: Retrospective data analysis of deidentified quality metric data was utilized to examine if treatment benchmarks set forth by the American Heart Association were met during the data collection period of January 2018 through September 2018. A voluntary survey was implemented at the rural medical facility to provide supplementary and clarifying information related to the treatment and coordination of transportation of ST-elevated myocardial infarction cases from February 2018 through August 2018 (n=3). Conclusions: Of the eight cases reviewed in this project, none met all of the applicable quality metric benchmarks; all eight met the door-to-ECG benchmark, one met the door-to-needle benchmark, none met door-to-door or door-to-balloon benchmarks. Providers in rural areas can provide quality care with positive clinical outcomes among ST-elevated myocardial infarction patients though adherence to treatment guidelines and working as a collaborative team with transporting agencies to facilitate rapid interfacility transportation (American Heart Association, 2015; National Clinical Guideline Centre, 2013).