Key result
Implementing a new STEMI activation algorithm requiring ED physician review reduced the hospital-wide STEMI cancellation rate from 68.8% to 20% without adversely affecting door-to-balloon time.
Why the study?
Does an ED physician-reviewed STEMI activation algorithm reduce STEMI cancellation rates compared to direct EMS activation?
Observational (n=73)
No
Does an ED physician-reviewed STEMI activation algorithm reduce STEMI cancellation rates compared to direct EMS activation?
Directing EMS-initiated STEMI activations to an ED physician for review significantly reduces false cath lab activations and improves staff satisfaction without compromising door-to-balloon goals.
Answers are grounded in this paper and cite their sources.
Supports ED review in STEMI activation to reduce cancellations; leaves open prospective multicenter validation.
Background The assumed national average of STEMI cancellations due to inappropriate activations is approximately 15%. In the final quarter of 2022, 57.9% of hospital-wide and 55.6% of ED/EMS STEMI activations were canceled at HCA Florida Orange Park Hospital. This cancellation rate contributed to overall “alarm fatigue” and hospital staff dissatisfaction over the hospital’s overuse of hospital resources. Methods An evaluation of the STEMI activation system revealed breakdown in communication from EMS to ED physician, inaccurate cardiology on-call schedule, and inefficient communication of case details between EMS, ED physician, and cardiologist. An algorithm was created that directed all STEMI activations from EMS to the ED physician for review, who may activate the STEMI alert or discuss the case with the on-call cardiologist. This plan was implemented and allowed a 30-day adjustment period. After this period, a prospective analysis of STEMI cancellations in the 2nd quarter of 2023 was performed with cath lab staff satisfaction surveys. Results The data on retrospective analysis of the final quarter of 2022 showed a STEMI cancellation rate of 68.8% hospital-wide and 66.7% from the ED and EMS. After the 30-day implementation of the plan, the hospital-wide STEMI cancellation rate dropped to 20% and 22% from the ED and EMS in the 2nd quarter of 2023 without adverse effect on door-to-balloon time. Conclusions The multidisciplinary approach to the creation and implementation of the new STEMI activation algorithm resulted in a significant reduction in false activations, improved cath lab staff satisfaction, and better utilization of hospital resources.
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Jacinto et al. (2025) conducted an observational in Suspected ST-segment elevation myocardial infarction (STEMI) (n=73). ED physician review of all out-of-hospital STEMI activations prior to alert activation vs. Standard pre-hospital STEMI activation by EMS was evaluated on Hospital-wide STEMI cancellation rate. Implementing a new STEMI activation algorithm requiring ED physician review reduced the hospital-wide STEMI cancellation rate from 68.8% to 20% without adversely affecting door-to-balloon time.
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