Abstract 166: Chasing the 90-Minute Target for First Medical Contact to Balloon (FMC2B) Time in EMS-Transported STEMI Patients at Two Teaching Hospitals

Background: AHA Guidelines establish a 90-minute target for First Medical Contact to Balloon (FMC2B) time in STEMI patients transported by emergency medical services (EMS) to STEMI-receiving centers. We describe the measures implemented and progress to date in achieving this new standard of care in two STEMI-receiving hospitals within one health system. Quality Improvement Goal and Data Sources: In Quarter 3 (Q3) 2011, our hospitals began participating in the AHA Mission: Lifeline program to build regional STEMI systems of care. We established a goal for each hospital to achieve the 90-minute FMC2B target in 75% or more of EMS-transported STEMI patients within at least one quarter in 2012. We used our AHA Mission: Lifeline reports (derived from our submitted ACTION-Registry GWTG data) to track our FMC2B times quarterly across five quarters (Q3 2011 through Q3 2012), and internal hospital data to determine the relationship between pre-hospital cath lab activation and achieving FMC2B targets. Interventions and Results: There were 36 and 43 STEMI patients respectively at each hospital who were eligible for FMC2B reporting over five quarters. Rates of achieving the 90-minute FMC2B target are shown before, during, and after implementation of seven hospital-wide interventions (Figure). Success rates were initially variable but improved in the last three quarters at both hospitals. One hospital reached the 75% consistency threshold for achieving the FMC2B target in Q1 2012, and both hospitals achieved a ≥70% success rate in the final reported quarter (Q3 2012). In both hospitals combined, 71.4% of patients with pre-hospital cath lab activation achieved the 90-minute FMC2B target, compared with only 50.0% when the cath lab was activated after hospital arrival (p=0.033). Equipment breakdown during attempted transmission of the pre-hospital ECG was a common reason for failure to activate the cath lab from the field. Conclusions and Next Steps: Consistent achievement of the 90-minute FMC2B target in STEMI patients requires unprecedented team-building and trust between EMS, ED, and cardiology personnel. A particular focus in 2013 will be increasing the rate of pre-hospital cath lab activations through EMS-to-ED phone calls when EMS is unable to transmit the field ECG to our hospitals.