Year of Publication

2015

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Melanie Hardin-Pierce

Clinical Mentor

Dr. Chandhiran Rangaswamy

Committee Member

Dr. Sheila Melander

Committee Member

Dr. Elizabeth Burckardt

Abstract

Purpose: The purpose of this project was to evaluate the implementation of an ST-elevation myocardial infarction (STEMI) Network into a large metropolitan healthcare system in Kentucky. The objectives of this project were to (1) determine if (and to what extent) the implementation of the STEMI Network decreased walk-in, emergency medical services (EMS), and transfer door to balloon (D2B) times at a STEMI receiving center at a metropolitan Kentucky academic hospital, (2) determine if there is a difference in treatment times for those individuals who present during working hours compared to non-working hours of the day, and (3) examine the associations between STEMI processes and specific patient characteristics (age, gender, race, body mass index, and various co-morbidities).

Setting: This project was conducted in an in-hospital invasive cardiovascular laboratory at a large metropolitan tertiary care and multi-organ transplant center located in Kentucky.

Population: Among the sample 69.9 % were male and 30.1 % were female. 80.1 % of the sample was Caucasian and 17.9 % were African American. Those included had an average age of 59 years (SD= 13.8), the mean body mass index (BMI) was 29.0% (SD=7.5), and 65.5% percent presented during non-working hours, while 34.5 % presented during working hours.

Inclusion criteria: Patients 18 years or older with the principal diagnosis of a STEMI who presented as a walk-in to the ED, via EMS directly to the receiving facility or as a transfer patient from one of the referring hospitals within a 35 mile radius of the receiving hospital during three separate time periods.

Design & Methods: A retrospective study of electronic medical record data was conducted to evaluate the efficacy of a STEMI Network during three separate four consecutive month long time frames. ICD-9 codes 410.0-410.9 and medical record numbers were obtained by the Information Technology Department at a large metropolitan hospital in Kentucky. The data review included age, gender, race, height, weight; history of hypertension, diabetes mellitus, prior MI; zip code of patient presenting via EMS; FMC time, door time, first medical contact time, EKG time, cardiac catheterization lab door time, and device time, and time of day categorized into working and non-working hours.

Results: When examining the comparison between the two cohorts pre-implementation (n=32) versus post-implementation (n=82) the overall mean D2B time dropped from a pre-implementation mean time of 136.3 minutes to 80.5 minutes (log p-value = .005). The interaction between D2B times and pre/post cohort group was statistically significant with a p-value = .017. Walk-in and transfer patients all had D2B times that decreased when comparing pre to post-implementation D2B times. While EMS patients did not show a statistically significant decrease in times, there was still a decrease from mean of 85 minutes to a mean of 76 minutes with those patients exhibiting the lowest overall D2B times. Furthermore, patients who presented during non-working hours (pre-implementation log mean time of 202 minutes and a post-implementation log mean time of 88 minutes) and as transfers (pre-implementation log mean time of 238.6 minutes and post-implementation log mean time of 88.8 minutes) seemed to have the greatest benefits of the STEMI Network.

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