Implementing "chest pain pathway" using smartphone messaging application "WhatsApp" as a corrective action plan to improve ischemia time in "ST-Elevation myocardial Infarction" in primary PCI capable center "WhatsApp-STEMI Trial".

BACKGROUND ST-elevation myocardial infarction (STEMI) is a life-threatening medical emergency that requires immediate medical attention, each hospital should implement a clinical pathway with a main objective to reduce ischemia time from diagnosis to revascularization, as this has shown to save myocardial tissues and subsequently patients' lives, utilizing the most evidence-based approach and the most up to date management protocol. In this study we aimed to assess the utility of structuring chest pain pathway with instantaneous case by case feedback protocol using WhatsApp as a smartphones' messaging application and its impact on improving two major KPIs, the impact on initial ER door to ECG time, and door to balloon time, in a predefined 6-month corrective action period. METHODS Prospective, quality improvement plan was set to reduce door to first ECG and door to balloon times to less than 10 and 90 minutes, respectively in all ACS cases including STEMI, from August 2020 to April 30th, 2021. Several measures were done to attain the goal including strict compliance to chest pain pathway with documentation, ruling out possible mimickers, reducing false activation and time delays in ER , Direct feed-back on cases was provided utilizing WhatsApp messaging app on smartphones , protocol and results of time lines were accessed by all health care providers involved with chest pain pathway including ER nurses, ER doctors, Cardiology residents, specialists, Cath lab nurses, technicians and interventionalists, bimonthly meeting with all stake holders were reinforced, minutes of meeting were reviewed and corrective actions were implemented the next day, all cases were analyzed and tabulated on daily basis by a dedicated nurse and a doctor from ER and another from quality assurance department. RESULTS After 6 month- period of implementing improvement plan and sticking to a comprehensive chest pain clinical pathways strategy with case-by-case review on a shared smart phone messaging application, the rate of door to first ECG improved from 76% to 93% in patients with chest pain and door to balloon time targeting less than 90 minutes improved significantly from only 77% to 92% in STEMI patient. This was statistically significant with p value of 0.0001, and 0.001 respectively, and the rate of false activation was reduced from 23% to 16% and 10% 3- and 6-months' time respectively with a significant p value< 0.01. finally, of patients with chest pains, strict 100 % rate of timely documentation was attained. CONCLUSIONS Improvement plan of implementing chest pain pathway, cut-time policy, using smartphone WhatsApp messaging for case-to-case instantaneous feedback have significantly improved key performance indicators and subsequently ischemia time in ACS including STEMI patients in 6-month time, indicating that this strategy works.