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 distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 teacher head, 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".