Electrocardiogram teletransmission and teleconsultation: essential elements of the organisation of medical care for patients with ST segment elevation myocardial infarction: a single centre experience.

BACKGROUND Optimal treatment of ST segment elevation myocardial infarction (STEMI) should be initiated immediately. System delay is considered an important indicator of quality of care in STEMI, and at the same time it is an independent predictor of clinical outcomes. It can be modified largely by introducing organisational changes. Although conditions have been created in Poland for common use of electrocardiogram (ECG) teletransmission and direct transfer of all STEMI patients to cardiac catheterisation laboratories, no uniform management algorithms have been introduced. AIM To summarize several years of our experience with the use of ECG teletransmission and teleconsultation system in a Polish rural region, present conclusions drawn from practical use of the suggested management algorithm, and compare effectiveness of this system in its early and established phases. METHODS The reported network consists of a single percutaneous coronary intervention (PCI)-capable hospital, emergency medical services (EMS) system, and several local non-PCI-capable hospitals. We extensively discussed the management algorithm based on prehospital diagnosis with ECG teletransmission and teleconsultation, and direct patient transfer to a PCI-capable hospital. Delays seen immediately after the system was introduced were compared with data obtained after several years of its stable functioning. RESULTS In 2005-2013, the average time to STEMI reperfusion therapy (total delay) was 282.3 (median 213) min, patient-related delay was 164.1 (median 74) min, and system delay was 116.8 (median 111) min. Primary PCI was performed in 93% of STEMI patients, with 21.1% of patients treated within 90 min after the first medical contact (FMC) and 61.1% of patients treated within 120 min after FMC. In 2006-2010, no significant change in the total delay was seen (340 min in 2006 vs. 311 min in 2010, p = 0.1429). A significant reduction was seen in the system delay both overall (-8.3%, p = 0.0318) and in hospital (-24.0%, p < 0.0001). Primary PCI was performed within 90 min after FMC in 14.0% of patients in 2006 and in 30.6% of patients in 2010 (+118.6%, p = 0.0049), and within 120 min after FMC in 55% and 62.2% of patients, respectively (p = 0.3008). The delay from FMC to the diagnosis decreased (-32.1%, p = 0.0356) but the overall EMS delay did not change (102.7 vs. 103.7 min, p = 0.6725). Patient transfer time to the cardiac catheterisation laboratory remained unchanged (54.8 vs. 60.1 min, p = 0.0828), as was the patient-related delay (161.9 vs. 150.2 min, p = 0.2801). CONCLUSIONS An ECG teletransmission and teleconsultation system reduces the system delay. ECG teletransmission systems work well in rural areas with low population density and a single large PCI-capable hospital. With increasing experience, a gradual increase in the effectiveness of management protocols involving ECG teletransmission is seen.