QI Note: Goals for chest pain patients

QI Note: Goals for chest pain patients

According to the American Heart Association, the primary goals of therapy for patients with Acute Coronary Syndrome (ACS) are to:

  • Reduce the amount of myocardial necrosis that occurs in patients with acute myocardial infarction (AMI), thus preserving left ventricular (LV) function, preventing heart failure, and limiting other cardiovascular complications; Prevent major adverse cardiac events (MACE): death, non-fatal MI, and need for urgent
    revascularization.
  • Treat acute, life-threatening complications of ACS, such as ventricular fibrillation (VF), pulseless ventricular tachycardia (VT), unstable tachycardias, symptomatic bradycardias, pulmonary edema, cardiogenic shock and mechanical complications of AMI

To accomplish the goals of the AHA for management of ACS, our goals for chest pain patients are as follows:

  • First Medical Contact (FMC defined as the time when both a 12-Lead ECG device (a capable LifePak) and a provider trained to acquire 12-Lead ECGs arrive at the patient’s side2) to completion of 12-Lead ECG: 10 minutes or less 2014 Average: 11 minutes
    • Pre-hospital 12-lead ECGs speed the diagnosis, shorten the time to reperfusion (fibrinolytics or primary percutaneous coronary intervention [PPCI]). EMS personnel should routinely acquire a
      12-lead electrocardiogram (ECG) as soon as possible for all patients exhibiting signs and symptoms of ACS.1
    • Take the LifePak inside the residence and obtain the 12 Lead ECG right away!
  • Time from 12-Lead ECG acquisition to transmission to hospital: 5 minutes or less 2014 Average: 5 minutes
  • Total ambulance on scene time: 15 minutes or less. 2014 Average: 16 minutes
  • Total EMS time (from Public Safety Access Point to arrival at ED): 30 minutes or less 2014 Average: 40 minutes
  • First Medical Contact (FMC) to balloon/device: 90 minutes or less 2014 Average: 103 minutes.

Documentation Tip:
Every time a 12 Lead ECG is acquired, the LifePak data needs to be imported into the ePCR.