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Designated fast tract improving the treatment of patients with ST elevation myocardial infarction.

Saban Mor, Salama R, Darawsha A, Shachar Tal

Introduction: A fast and correct diagnosis of ST Elevation Myocardial Infarction (STEMI) in the emergency department (ED) significantly correlates with decreased morbidity and mortality. Nevertheless, delayed diagnosis still occurs in 5%-15% of the patients who were diagnosed with STEMI. Objective: To evaluate a 'fast-track' program to reduce door-to-balloon time (DTBT) in patients with STEMI, who present to ED triage with chest pain. Methods: A retrospective-archive study was conducted to evaluate and compare the adherence to clinical guidelines between all STEMI patients (n=140) who attended the ED before (i.e. throughout 2015, n=60) and after (i.e. throughout 2016, n=80) the intervention program was implemented. The program comprised of four steps: 1) Immediate bed rest; 2) Marking the patient chart with a dedicated sticker; 3) Assessing the time-lags according to defined clinical guidelines; and 4) Signing a dedicated sticker on the ECG by the physician. Results: We observed a significant post-intervention improvement in adherence to clinical guidelines. While pre-intervention, an ECG was conducted within 10 minutes for only 40% (n=24) of patients, the post-intervention percentage increased to 57.5% (n=46) (P=0.04). Similarly, while 61.7% (n=37) of patients were re-perfused within 90 minutes in the catheterization coronary lab, the post-intervention percentage increased to 70% (n=56) (P=0.30). During program implementation, more patients were classified correctly in life threatening (P1) and severe (P2) categories (n=18, 30% vs. n=40, 50%; p