The sunshine coast STEMI pilot: An integrated network model for immediate transfer of regional patientS to a PCI-capable hospital

Abstract

Background: For STEMI patients presenting to regional non-PCI capable hospitals, the benefit of immediate transfer and early PCI (the 'pharmacoinvasive approach') has been demonstrated in several randomised trials. We sought to evaluate the impact of an integrated model for immediate transfer of such patients on door-to-door transfer times. Methods: An integrated system involving a large regional hospital, transport services and two PCI-capable Brisbane tertiary hospitals was developed to evaluate the impact on post-thrombolysis STEMI transfer times. The average door-to-door transfer time from regional to tertiary Hospital (distance ~100 km) was compared for all STEMI patients eight months before and six months after commencement of this system. Prior to this system, the regional hospital decided when to refer for transfer on a patient-by-patient basis, and acceptance / initiation of transfer required multiple, separate points of contact. In this system, all patients were referred at presentation through a single point of contact (the dedicated 'STEMI Hotline', through which the patient was accepted and transfer activated). Results: All 40 acute STEMI patients presenting to the regional hospital over a 14 month period were included (age 63.02+/-14.44 years, 80% male). Pre-system, the average transfer time was 14.1+/-14.1 h (n = 25, range 3-46 h). Post-system, average transfer time fell to 4.8+/-2.6 h (n = 15, range 2-11 h), p = 0.01. There were no significant differences in baseline characteristics between the pre-system and post-system patients. Conclusion: An integrated system of transfer for regional STEMI patients is feasible and led to significant improvement in transfer times. Plans are nowunderway to extend this pilot to further Southeast Queensland regional centres.<br />