Year of Publication
Doctor of Nursing Practice
Dr. Melanie Hardin-Pierce
Dr. Chandhiran Rangaswamy
Dr. Sheila Melander
Dr. Elizabeth Burckardt
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.
Evers, Julianne M., "The Efficacy of STEMI Networks and Systems of Coordinated STEMI Care: An Evaluation of the Implementation of a STEMI Network" (2015). DNP Projects. 37.