Improving In-hospital STEMI Outcomes: Utilizing Hospital Nurse Empowered Cath Lab Activation Protocol

Background
Recently published data suggests in-hospital STEMI patients received less re-perfusion therapy, and higher in-hospital mortality rates.

Methods
Cox Health South, a level I STEMI center in Springfield, MO has a high volume cardiovascular practice with 6 Catheterization labs. We have noticed delays in In-hospital STEMI activations, reperfusion and potential targets for strategies to improve processes and systems of care for this population. Identified delays were associated with ECG interpretation and provider contact delays. New protocol was implemented utilizing nurse initiated STEMI activation mirroring the emergency department and pre-hospital STEMI activation policy. Times and processes were tracked, providing feedback for continuous process improvement.

Results
Compared 10months data pre and post implementation of protocol. 3 to 5% constitute inpatient STEMI’s. Data suggests more inpatients activations and improvement in time to reperfusion from 84.4minutes to 71.5minutes post-protocol as detailed in the table.

Conclusions
Our study demonstrates improvement in activations and time to perfusion with implementation of dedicated In-hospital STEMI protocols focused on early recognition and treatment mimicking EMS and ER STEMI protocols.