F-125 | Time Is Muscle? Evaluating the Impact of a Rapid Triage (‘Red Card’) Program on STEMI Process Metrics

Background: Timely reperfusion in ST-segment elevation myocardial infarction (STEMI) is critical to reducing morbidity and mortality.Current American College of Cardiology guidelines recommend a doorto-electrocardiogram (ECG) time 10 minutes and a door-to-balloon (DTB) time 90 minutes.To expedite STEMI recognition and catheterization laboratory activation, a rapid triage "Red Card" program was implemented at our institution to prioritize chest pain presentations as potential STEMI cases.Methods: A retrospective analysis of consecutive STEMI presentations was performed at a community hospital in California during 2024.The Red Card program was implemented in September 2024.Process metrics including door-to-ECG, ECG-to-cardiology consultation, door-to-pre-operative evaluation, and DTB times were collected.A total of 127 STEMI cases were identified, including 86 prior to and 41 following program implementation.Outcomes were compared using odds ratios for achievement of guideline-recommended benchmarks.Results: Following implementation of the Red Card program, mean door-to-ECG time increased from 3.5 to 10.2 minutes, with a lower proportion of patients achieving ECG acquisition within 10 minutes (71% pre-implementation vs. 51% post-implementation; OR 0.43, p=0.046).Mean door-to-balloon time increased from 76 to 82 minutes, with no significant difference in the proportion achieving DTB 90 minutes (74% vs. 66%; OR 0.66, p=0.40).Mean ECG-to-cardiology consultation time was 12.5 minutes, and mean door-to-pre-operative evaluation time was 49 minutes, indicating delays at several stages of care.Conclusions: Implementation of a rapid triage Red Card program was not associated with improvement in DTB performance and was paradoxically associated with longer door-to-ECG times.These findings suggest that prioritization protocols alone may be insufficient to improve STEMI process metrics without concurrent optimization of interdepartmental communication and workflow integration.Improving STEMI care may require broader system-level interventions to enhance coordination between emergency physicians and cardiologists.