Innovations in Care Improving Use of Prehospital 12-Lead ECG for Early Identification and Treatment of Acute Coronary Syndrome and ST-Elevation Myocardial Infarction

Background—Performance of prehospital ECGs expedites identification of ST-elevation myocardial infarction and reduces door-to-balloon times for patients receiving reperfusion therapy. To fully realize this benefit, emergency medical service performance must be measured and used in feedback reporting and quality improvement. Methods and Results—This quasi-experimental design trial tested an approach to improving emergency medical service prehospital ECGs using feedback reporting and quality improvement interventions in 2 cities’ emergency medical service agencies and receiving hospitals. All patients age 30 years, calling 9-1-1 with possible acute coronary syndrome, were included. In total, 6994 patients were included: 1589 patients in the baseline period without feedback and 5405 in the intervention period when there were feedback reports and quality improvement interventions. Mean age was 66 17 years, and women represented 51%. Feedback and quality improvement increased prehospital ECG performance for patients with acute coronary syndrome from 76% to 93% (P 0.0001) and for patients with ST-elevation myocardial infarction from 77% to 99% (P 0.0001). Aspirin administration increased from 75% to 82% (P 0.001), but the median total emergency medical service run time remained the same at 22 minutes. The proportion of patients with door-to-balloon times of 90 minutes increased from 27% to 67% (P 0.006). Conclusions—Feedback reports and quality improvement improved prehospital ECG performance for patients with acute coronary syndrome and ST-elevation myocardial infarction and increased aspirin administration without prehospital transport delays. Improvements in door-to-balloon times were also seen. (Circ Cardiovasc Qual Outcomes. 2010;3:316-323.)