Five years in: A look back at a cardiovascular STEMI receiving center system in a large metropolitan county

Background: Over one million Americans suffer acute myocardial infarctions (AMI), 375,000 will die before receiving care. A third have ST-Segment Elevation Myocardial Infarction or STEMIs, a type of AMI easily detected by 12-lead ECGs. In 2007, the County of San Diego Emergency Medical Services in collaboration with local hospitals and cardiologists launched a STEMI Receiving Center (SRC) System to care for 11,000 9-1-1 cardiac chest pain patients transported to the Emergency Department (ED) annually, 400 had STEMIs. This system allows Prehospital ALS personnel to alert hospitals of possible STEMIs to expedite life saving interventions. Methods: Thirteen EDs met qualifications thus designated SRC. The data collection practice shifted from a paper process to an electronic fillable form using widely available software. Data collected was modified to match national data established by the American College of Cardiology allowing more accurate analysis and comparison of demographics, specific interventions, dates/times, and outcomes. Results: Almost five years and over 3000 Prehospital STEMI patients later this specialty care system has proven worthy. Percent of patients with an arrival at the ED to intervention/balloon inflation (Door-To-Balloon time/DTBT) 90 minutes or less has increased; pre-system sample data DTBT was 86% compared to 97% for 2010. Other improved patient outcomes and additional system improvements will be presented. Conclusions: California is in the midst of establishing State regulations for STEMI systems. Lessons learned from successful, functioning systems can help shape the design of regulations and focus on comparable local, state and national system criteria for surveillance and quality measures.