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Quality Summit Research Identifies Persistent Challenges in AMI Care Post COVID-19

Door-to-balloon (D2B) times for patients presenting with acute myocardial infarction (AMI) continue to lag as health care facilities struggle to recover from the COVID-19 pandemic, according to a study being presented at ACC Quality Summit 2023, kicking off Oct. 11 in Orlando, FL.

Using CathPCI Registry data, Sara Belajonas, MSN, MBA, CCRN, APN-C, and Jeanne Jacobus, MSN, RN, from Ocean University Medical Center in Brick Township, NJ, identified a trend of climbing D2B times. The center averaged 60 minutes for the two years before the COVID-19 pandemic; however, data from the first quarter of 2022 revealed an average D2B time of 73 minutes.

Researchers conducted a review of the center’s heart attack care processes, including door-to-electrocardiogram (ECG), arrival to STEMI activation, arrival to case start and D2B, and determined that patients presenting with AMI were spending too much time in the emergency department. This delay was due to an assortment of reasons, including nurse and emergency medical services (EMS) worker shortages. They also found that not all STEMIs brought in by Advanced Life Support units were pre-activated.

Belajonas and Jacobus implemented several strategies to reduce D2B times, including re-education of the multidisciplinary team; involvement of additional staff to assist in the process; review of all STEMI cases with time interval drill down; re-education on ACC recommendation to pre-activate all field STEMIs regardless of transmitted ECG; re-education on STEMI prep; annual STEMI drills completed, including new heart and vascular to familiarize staff with the cath lab; and collaboration with EMS to drill down transport delays.

Recent data show that the re-education and refocusing on time and AMI care processes for facility staff decreased D2B times. While at the end of 2022 times had only decreased from 73 to 72 minutes, average D2B time for the center in August 2023 were lowered to 60 minutes.

“Some of the new national standards created in response to the COVID-19 pandemic created obstacles to heart attack care by adding minutes to D2B time,” said Belajonas. “I believe this created a scenario that our STEMI process was not utilized as often, therefore creating the need for re-education and the refocusing on the importance of time.”

ACC’s Quality Summit puts the spotlight on the value of ACC Accreditation and NCDR services to enhance health care quality. Cardiovascular clinicians and stakeholders across the U.S. will converge at this year’s Summit to discuss the role of accreditation and registries in health equity initiatives, best practices for rebooting and rebranding health care quality, and strategies to engage the entire cardiovascular care team in the quality process.

Other abstracts presented at this year’s summit include:

  • Reducing Door-in-Door-Out Time For STEMI at a Rural Non-PCI Acute Care Facility
  • Implementing a Clinical Decision Support Tool to Improve Cardiac Rehabilitation Referral
  • Optimizing the Inpatient Chest Pain Alert Process
  • Improving Door to ECG Compliance For Patients Arriving With EMS

For more coverage of the conference, check out the meeting’s digital newspaper, use the hashtag #ACCQuality23 and follow the ACC on social media.

Clinical Topics: COVID-19 Hub, Stable Ischemic Heart Disease, Vascular Medicine, Chronic Angina

Keywords: Patient Care Team, Accreditation, Referral and Consultation, Registries, Emergency Service, Hospital, Electrocardiography, Myocardial Infarction, COVID-19, COVID-19, Inpatients, Pandemics, ST Elevation Myocardial Infarction, ACC Accreditation, National Cardiovascular Data Registries, Quality Summit, Quality Improvement

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