Abstract 16674: Using Novel Emergency Medical Services Data-Linkage to Evaluate the Timing and Quality of Pre-Hospital ST-Elevation Myocardial Infarction Care
Background: Current national guidelines state that STEMI patients should receive primary percutaneous coronary intervention (PCI) within 90 minutes of “first medical contact” (FMC). Lacking access to emergency medical services (EMS) data, many hospitals are unprepared to implement this goal. Our objective was to utilize a novel statewide hospital/EMS data linkage to describe pre-hospital delays in care and to examine adherence to the 90 min rule.
Methods: To assess pre-hospital patterns of care in North Carolina (NC), we linked data from the ACTION-GWTG registry and the statewide EMS Pre-hospital Medical Information System (PreMIS) from 06/2008 to 09/2010. We calculated the discrete elements of pre-hospital delay from the time of 911-activation to the time of hospital arrival using PreMIS data and in turn compared time from FMC to hospital arrival as recorded in PreMIS versus ACTION.
Results: Analyses included 21 ACTION hospitals and 178 EMS agencies across NC. Of 6010 linked STEMI patients, 3077 (51%) arrived directly to a PCI capable hospital by EMS. Median age was 60 (IQR 52-71) and 69% were men. Calculated pre-hospital times are shown in the Table. Median total pre-hospital time interval was 42 min (IQR 33-53). Comparing PreMIS to ACTION data, time from FMC to hospital arrival was 30 min (IQR 23-40) vs. 34 min (IQR 26-45) with median difference of 3 minutes (IQR 0-7, p <.0001 by signed rank test). Among patients with available data in both data sources (n= 2201), only 53% achieved the metric of PCI within 90 min of FMC by PreMIS and 49% by the ACTION data with 12% discordance between ACTION and PreMIS (p <.0001 by McNemar's test).
Conclusions: This work demonstrates that it is possible to link nationally representative hospital and EMS data for assessing the quality of pre-hospital STEMI care and further shortening treatment times. Pre-hospital data may also permit more accurate determination of first medical contact time than hospital data sources.
- Percutaneous coronary intervention
- Myocardial infarction, STEMI
- Myocardial revascularization
- Quality assessment
- © 2011 by American Heart Association, Inc.