Abstract 166: Chasing the 90-Minute Target for First Medical Contact to Balloon (FMC2B) Time in EMS-Transported STEMI Patients at Two Teaching Hospitals
Bibliographic record
Abstract
Background: AHA Guidelines establish a 90-minute target for First Medical Contact to Balloon (FMC2B) time in STEMI patients transported by emergency medical services (EMS) to STEMI-receiving centers. We describe the measures implemented and progress to date in achieving this new standard of care in two STEMI-receiving hospitals within one health system. Quality Improvement Goal and Data Sources: In Quarter 3 (Q3) 2011, our hospitals began participating in the AHA Mission: Lifeline program to build regional STEMI systems of care. We established a goal for each hospital to achieve the 90-minute FMC2B target in 75% or more of EMS-transported STEMI patients within at least one quarter in 2012. We used our AHA Mission: Lifeline reports (derived from our submitted ACTION-Registry GWTG data) to track our FMC2B times quarterly across five quarters (Q3 2011 through Q3 2012), and internal hospital data to determine the relationship between pre-hospital cath lab activation and achieving FMC2B targets. Interventions and Results: There were 36 and 43 STEMI patients respectively at each hospital who were eligible for FMC2B reporting over five quarters. Rates of achieving the 90-minute FMC2B target are shown before, during, and after implementation of seven hospital-wide interventions (Figure). Success rates were initially variable but improved in the last three quarters at both hospitals. One hospital reached the 75% consistency threshold for achieving the FMC2B target in Q1 2012, and both hospitals achieved a ≥70% success rate in the final reported quarter (Q3 2012). In both hospitals combined, 71.4% of patients with pre-hospital cath lab activation achieved the 90-minute FMC2B target, compared with only 50.0% when the cath lab was activated after hospital arrival (p=0.033). Equipment breakdown during attempted transmission of the pre-hospital ECG was a common reason for failure to activate the cath lab from the field. Conclusions and Next Steps: Consistent achievement of the 90-minute FMC2B target in STEMI patients requires unprecedented team-building and trust between EMS, ED, and cardiology personnel. A particular focus in 2013 will be increasing the rate of pre-hospital cath lab activations through EMS-to-ED phone calls when EMS is unable to transmit the field ECG to our hospitals.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".