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Forrest General Hospital's STEMI Care System Update
Forrest General Hospital's STEMI Care System is now one year old and is making a difference in the lives of south Mississippians who suffer an ST Elevation Myocardial Infarction or STEMI. In STEMI care, the most important therapy to reduce mortality and morbidity rates is rapid reperfusion therapy by Primary Percutaneous Intervention (balloon angioplasty). Our goal and the standard is to achieve Door to Balloon (D2B) times of 90 minutes or less in 75% of patients who present to our ED with STEMI and to achieve a Door to Balloon time of 120 minutes or less in transferred patients.
In 2010, 92 patients presented to Forrest General Hospital with STEMI and our average D2B time was 60 minutes with 96% of patients achieving a D2B time less than 90 minutes. While transfer D2B time reduction has been a challenge due to transportation issues, D2B times as low as 66 minutes have been achieved when patients were transferred from outlying hospitals.
Our success has been due to the efforts of multiple departments and personnel from the Cardiology Department, Cardiac Cath Lab, Emergency Department, EMS Services and Administration. We have implemented several important processes including:
• Initiation of a STEMI Committee which meets monthly. This committee includes ED Physicians, Cardiologist, Cath Lab nurses and manager, ED nurses and managers, AAA Ambulance Services and Administrators. This committee has been instrumental in overcoming barriers to system implementation.
NEWS FOR EMPLOYEES OF FORREST GENERAL
• Standardized drug protocols in the Emergency Department so that every patient is treated the same regardless of which ED physician or Cardiologist is on call. This decreases the time to initiation of therapy.
• Empowering the ED Physician to activate a "Code STEMI" prior to speaking with the Cardiologist and activating the "Code STEMI" by one burst page which activates the Cath Lab team, Interventional Cardiologists, Nursing Supervisor and CCU.
• All ED nursing personnel are receiving standardized STEMI system training with the American Heart Association's "Learn Rapid STEMI ID" program.
• Data collection through the ACTION Registry for quality control and analysis. We now have collected data for the 3rd quarter of 2010 and have submitted this data to the national registry.
• We have met with a number of outside referring hospitals (NonPCI Hospitals) and have now "rolled in" South Central Regional Medical Center and Highland Community Hospital. These facilities are now empowered to activate a "Code STEMI" from their Emergency Departments. Other facilities will be activated in the near future.
• Hiring of a full time STEMI Coordinator, Michael Collins NREMT, APRN, MSN, CEN, NP-BC who brings years of experience in emergency and critical care nursing, including experience as a flight nurse for Baptist LifeFlight Air Ambulance service. Michael recently completed his Emergency Nurse Practitioner degree from the University of South Alabama.
• Participation and leadership in the Mississippi Healthcare Alliances' statewide STEMI Care Project.
Future exciting developments and improvements in the system will occur in 2011. We are very close to implementing a 12 lead ECG system in all 40 AAA Ambulances. When this system is in place it is anticipated a significant improvement in D2B times as well as transfer times can be achieved. Our goal is to reduce morbidity and mortality from ST Elevation Myocardial Infarction and one day be able to make the claim that the Pine Belt is the "The Safest Place in Mississippi to have a Heart Attack".
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