Fast Track Protocol for ST-Elevation Myocardial Infarction (STEMI) to Minimize Treatment Delays
Mayo Clinic, Division of Cardiovascular Diseases
Rochester, Minnesota, USA
Team
Henry H. Ting, MD, Practice Chair, Division of Cardiovascular Diseases
Malcolm R. Bell, MD, Director of Coronary Care Unit, Division of Cardiovascular Diseases
Charanjit S. Rihal, MD, Director of Cardiac Catheterization Lab, Division of Cardiovascular Diseases
David L. Hayes, Chair, Division of Cardiovascular Diseases
John F. Bresnahan, MD
Luis H. Haro, MD
Angela M. Wills, Outpatient Practice Operations Manager, Division of Cardiovascular Diseases
Megan B. Lamp, RN, Mayo One Air Ambulance Flight Team
Stephen F. Pieper, RN
Lavon N. Hammes
Choon-Chern Lim
Eric Yang, MD
Aim
To improve process metrics (time to treatment) and clinical outcomes in ST-Elevation Myocardial Infarction (STEMI) patients presenting to regional community hospitals without percutaneous coronary intervention (PCI) capability by:
- Implementing a standard treatment protocol utilizing current evidence-based medicine and AHA/ACC Guidelines (Mayo Clinic FAST TRACK Protocol for STEMI)
- Applying lean and Six Sigma methodology to improve clinical care processes and to achieve optimal door-to-balloon time and door-to-thrombolytic time
Measures
Changes
From December 2004 to August 2005, 15 regional community hospitals within 120 nautical miles from Mayo Clinic participated in the FAST TRACK Protocol project.
- For STEMI with onset of symptoms <3 hours, thrombolysis and transfer is preferred.
- For STEMI with onset of symptoms >3 hours, transfer for primary PCI is preferred.
Innovations in clinical care processes include:
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Prioritizing electrocardiogram acquisition at the regional hospital
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Single phone call to activate the protocol and transport
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Central air ambulance transport center selects fastest mode of transport
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Regional hospital physician activates the Catheterization Lab
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Standard guideline for selecting reperfusion strategy and adjunctive medications
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Helicopter engine left running to minimize ground time
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Glycoprotein IIB-IIIa inhibitor administered en route by transport nurses
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Group display paging Catheterization Lab team
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Patient transferred directly to the Catheterization Lab for primary PCI
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Prospective web-based data collection tool
Results
 
Summary of Results / Lessons Learned / Next Steps
- Significant treatment delays exist for STEMI patients presenting to regional community hospitals without PCI capability (door-to-balloon time and door-to-thrombolytic time).
- Standard treatment protocols and lean/Six Sigma process changes can improve time metrics for STEMI reperfusion therapy. Ongoing clinical research to measure the impact on clinical outcomes.
- Reperfusion therapy and adjunctive pharmacotherapy for STEMI utilizing current evidence-based medicine and AHA/ACC Guidelines should be rapidly implemented and updated.
Contact Information
Angie Wills, Outpatient Practice Operations Manager
Mayo Clinic, Division of Cardiovascular Diseases
wills.angela@mayo.edu
[Storyboard presentation at IHI's National Forum, December 2005]
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