Purim-Shem-Tov Yanina A, Schaer Gary L, Malik Kaleem, McLaughlin Robert R, Haw Janet M, Melgoza Norma A, Franco Mary M
From the *Rush University Medical Center, Chicago, IL; †St Anthony Hospital of Chicago, Chicago, IL; and ‡Superior Ambulance Service, Chicago, IL.
Crit Pathw Cardiol. 2014 Dec;13(4):131-4. doi: 10.1097/HPC.0000000000000025.
Patients with ST-segment elevation myocardial infarction (STEMI) greatly benefit from a rapid door-to-balloon (D2B) time. For hospitals without a catheterization laboratory, it is imperative to establish partnerships with a STEMI receiving center (SRC). STEMI systems of care have been established to facilitate these relationships to improve rapid reperfusion. We describe the experience and benefits of such a relationship.
A partnership between our 2 institutions was established in April 2011. Saint Anthony Hospital (SAH) of Chicago is an inner city hospital with interventional cardiologists on staff, but no catheterization laboratory. Before the partnership, STEMI patients were transferred 8 miles to a percutaneous coronary intervention (PCI) hospital on the city's north side. Rush University Medical Center (RUMC) is an academic medical center with 24/7/365 PCI capability. SAH decided that a transfer relationship with a closer SRC would benefit patient care. The following steps were taken: both hospitals signed a STEMI transfer agreement for STEMI transfers regardless of insurance status; an education process occurred at both hospitals; agreement that transferred patients would follow-up at the STEMI referring hospital (SAH); a contract with a single ambulance provider was signed; a simple STEMI protocol was adopted.
In 2010, SAH saw 20 patients with STEMI. Average time from patient arrival to leaving the emergency department (ED) [Door-in-Door-out (DIDO)] was 83 minutes, these times were not tracked carefully; approximate transfer time to SRC was 25 minutes; Door1-2-Balloon (D12B) time was not recorded. Since the new protocol, 44 patients transferred to RUMC for PCI to date. Median (inclusive minimum, maximum) time from ED arrival (D1) at referral hospital to SRC (D2) was 52 minutes (56, 192) for all PCI cases; 11 patients transferred did not have PCI; 1 patient expired upon arrival; and median time to first PCI device (D12B) was 86 minutes (53-167).
Streamlining STEMI patient care to reduce D2B is a major priority. We have demonstrated that establishing a transfer program between a STEMI-Referral Hospital (SRH) and SRC can markedly improve time to reperfusion. This approach has resulted in D12B that match or exceeds the D2B for nontransfer patients at most STEMI-receiving hospitals.
ST段抬高型心肌梗死（STEMI）患者能从快速的门球时间（D2B）中极大受益。对于没有导管室的医院而言，与STEMI接收中心（SRC）建立合作关系至关重要。已建立STEMI护理系统以促进这些关系，从而改善快速再灌注。我们描述了这种合作关系的经验和益处。
我们两家机构于2011年4月建立了合作关系。芝加哥的圣安东尼医院（SAH）是一家市中心医院，有介入心脏病专家，但没有导管室。在合作关系建立之前，STEMI患者被转送到该市北区一家具备经皮冠状动脉介入治疗（PCI）能力的医院，距离为8英里。拉什大学医学中心（RUMC）是一家具备全年无休PCI能力的学术医疗中心。SAH认为与更近的SRC建立转诊关系将有利于患者护理。采取了以下步骤：两家医院签署了一份STEMI转诊协议，无论保险状况如何，均可进行STEMI转诊；两家医院都开展了教育过程；达成协议，转诊患者将在STEMI转诊医院（SAH）进行随访；与一家救护车供应商签署了合同；采用了一个简单的STEMI方案。
2010年，SAH接诊了20例STEMI患者。从患者到达至离开急诊科（ED）的平均时间[门到门（DIDO）]为83分钟，这些时间未得到仔细跟踪；转送至SRC的大致时间为25分钟；门1至球囊（D12B）时间未记录。自新方案实施以来，截至目前已有44例患者转至RUMC进行PCI。所有PCI病例从转诊医院急诊科到达（D1）至SRC（D2）的中位时间（包括最小、最大时间）为52分钟（56，192）；11例转诊患者未进行PCI；1例患者到达时死亡；首次PCI装置置入的中位时间（D12B）为86分钟（53 - 167）。
简化STEMI患者护理以缩短D2B是一项主要优先事项。我们已证明，在STEMI转诊医院（SRH）和SRC之间建立转诊计划可显著改善再灌注时间。这种方法所实现的D12B时间与大多数STEMI接收医院非转诊患者的D2B时间相当或更长。
