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Research Letter
December 2016

A Quality Improvement Program for Recognition and Treatment of Inpatient ST-Segment Elevation Myocardial Infarctions

Author Affiliations
  • 1Division of Cardiology, University of North Carolina, Chapel Hill
  • 2McAllister Heart Institute, University of North Carolina, Chapel Hill
JAMA Cardiol. 2016;1(9):1077-1079. doi:10.1001/jamacardio.2016.3031

Rapid reperfusion with percutaneous coronary intervention or thrombolytic therapy is the standard of care for ST-segment elevation myocardial infarction (STEMI). STEMIs that occur in hospitalized patients have delayed symptom recognition, longer times from electrocardiography (ECG) to first-device activation (FDA), lower rates of percutaneous coronary intervention, and higher mortality rates compared with outpatient STEMIs.1-6

We identified the barriers contributing to these delays and implemented a quality improvement program (QIP) to enhance the response to inpatient STEMIs. Our QIP included the following 4 specific interventions: (1) a hospital-wide education campaign aimed at nurses, medical teams, and allied health care professionals on the recognition of inpatient STEMI and the importance of the timely reperfusion; (2) a requirement that ECG technicians and nurses immediately notify the cardiologist if the automated interpretation of an ECG included ***acute MI***; (3) establishment of an inpatient STEMI protocol and a cardiac response team, modeled on the rapid response team; and (4) monthly review of each inpatient STEMI.