Development and implementation of the inpatient rapid Myocardial Infarction (MI) Pathway at Epworth Richmond.

Abstract

Background. Guidelines for cardiac catheter laboratory intervention in ST-elevation myocardial infarction (STEMI) emphasise the critical need for rapid revascularisation of coronary arteries. However, it was recognised that at Epworth Richmond, there were unnecessary, lengthy delays in the transfer of inpatients with suspected STEMI to the Catheter Laboratory. In response, we initiated a process of change management to facilitate rapid Catheter Lab activation and transfer for eligible patients. Methods. We reviewed The Cardiac Society of Australia and New Zealand guidelines for the management of Acute Coronary Syndromes and adapted best practice recommendations to inpatient care. A consensus process involving widespread consultation with key stakeholders was undertaken. This resulted in the development of the Inpatient Rapid MI Pathway implemented in November 2017. Results. The Inpatient Rapid MI Pathway clarified key staff roles, responsibilities and processes related to the transfer of patients with suspected MI to the Catheter lab, with the aim of facilitating transfer within 45 minutes of the first ECG taken. Early data suggest that implementation of the Pathway has considerably decreased the time taken to transfer inpatients to the Cath Lab. Mean ‘onset of symptom to balloon time’ before was 150.8 minutes (n=9) and post implementation was 62.7 minutes (n=4). Discussion. The Inpatient Rapid MI Pathway has been effective in streamlining the early identification and treatment of patients with STEMI through clear delineation of roles and processes. Further ongoing evaluation and review is required to refine processes, ensure sustainability, and determine its effect on MI-related morbidity and mortality.