North Dakota Cardiac System of Care Hospital Designation

PRE-HOSPITAL CARE

Collaboration with local EMS to allow for pre-hospital activation of STEMI process
Documentation supporting hospitals reaching back to EMS to provide patient outcomes, what went well, opportunities for improvement on cardiac arrest calls (feedback forms, integration of quarterly meetings, etc.)
EMS to provide current contact information to hospital facility

EMERGENCY ASSESSMENT OF STEMI PATIENTS

ED triage protocol that includes a stat ECG (<10 minutes after arrival) for patients with
Acute Coronary Syndrome (ACS) based signs and symptoms, including atypical presentations
ED treatment protocol(s) for diagnosis and treatment of the STEMI patient
STEMI activation plan
STEMI Team with required experience or competency/skills validation in STEMI care
STEMI Team ACLS certified
STEMI Team response to bedside <20 min.
Acute Cardiac Team members have one-hour training and education annually specific to
STEMI recognition, identification, treatment, and transfer (not including BLS or ACLS recertification)

TREATMENT

Documentation of reperfusion strategy(ies) (Fibrinolytics vs Primary PCI)
Protocol that outlines each step in STEMI treatment and transfer process that follows
current clinical practice guidelines (Examples include goal metrics for Door to ECG within 10 minutes of arrival, Door to transport activation and Door-in to Door-out within 45 minutes, Arrival to Thrombolytics within 30 minutes)
Documentation by provider on why the patient did not receive fibrinolytic therapy
Provide STEMI order sets which include current clinical practice guidelines
Ensure consent for fibrinolytic therapy (oral/emergent)

FIBRINOLYTIC THERAPY

Provide order sets/protocols for fibrinolytic therapy administration
Documentation of fibrinolytic checklist use
Documentation of the process in place when the STEMI patient is not eligible for fibrinolytic therapy
Documentation of annual Tenecteplase (TNK) administration refresher for STEMI Team
IV TNK available 24/7 (Recommend: 2 doses TNK available)
North Dakota STEMI Referring Hospital Center Designation Requirements – Version 7/2021

TRANSFER PROCESS

Transport plans or agreement for STEMI patient to be transferred to a PCI capable center
Documentation where expected length of stay in ED for STEMI patients transferred for PCI > 45 minutes (Door-in to Door-out)

PERSONNEL

STEMI Coordinator name and leadership roles specific to STEMI Systems of Care
Name of Medical Director/Physician Champion and leadership roles specific to STEMI Systems of Care
Designated smoke free campus

PROCESS IMPROVEMENT

STEMI activation log
Process improvement documentation, keeping track of quality metrics and addressing outliers, why the metric is an outlier, and what has been done to improve outliers
Report metric data at interdisciplinary meeting (including EMS personnel), can be built into an already existing quarterly meeting or can be a meeting on its own.
Use of cardiac registry with capabilities for state reporting
Performance improvement program must include, but not limited to, tracking the following metrics:
- Door to ECG within 10 minutes
- STEMI positive ECG to EMS transport activation within 10 minutes
- Door to fibrinolytics (in fibrinolytic eligible patients) <30 minutes
- Door-in door-out time (length of stay) < 45 minutes
- Aspirin given prior to transfer
- Loading dose of Plavix or Brilinta prior to transfer
- Loading dose of weight-based Heparin
- If fibrinolytics given, initiation of Heparin drip
Review of hospital and pre-hospital STEMI care