Utilizing Visual Workflows and Telemedicine To Improve Rural Acute Cardiovascular Patient Transfers

Abstract

Purpose: This project aims to (1) establish standardized processes for transferring acute ST-segment elevation myocardial infarction (STEMI) patients from Southern Arizona Critical Access Hospital to Southern Arizona Urban Medical Center (TMC) and (2) assess the confidence level of providers following a mock patient scenario utilizing visual workflows describing the new process. Background: The American College of Cardiology (ACC) recommends transfer from facilities unable to perform percutaneous coronary intervention (PCI) to PCI-capable facilities to achieve initial patient contact to angioplasty balloon inflation time of 120 minutes to reduce the area of damage to the myocardium. Transferring patients from rural health centers to PCI-capable health centers is multifactorial and requires effective communication and coordination from multiple team members; delay is, unfortunately, a common occurrence. Therefore, the ACC also recommends fibrinolytic therapy for patients unable to meet the 120-minute time goal when indicated, which should be completed within 60 minutes of the patient's arrival at the rural health center. Unfortunately, fibrinolytic therapy does not always stop the myocardial infarction from progressing; therefore, the transfer must still be completed expediently to bring the patient to a PCI-capable facility. Multiple patient care decisions must be made efficiently; therefore, clear and concise workflows with standardized procedures are vital to provider confidence. Methods: This quality improvement project utilized a posttest-only design and implemented an educational presentation and mock patient scenario to test new standard protocols. The participants included physicians, advanced practice providers (APPs), and registered nurses. The posttest included ordinal questions regarding the level of confidence and open-ended questions, which were evaluated using qualitative review methods. Results: Of the 14 participants who attended the educational presentation and mock scenario, 8 returned a completed posttest. Confidence increased in the following areas: STEMI recognition, fibrinolysis treatment decisions, and communication with TMC during transfer. Participants provided positive feedback regarding the new standard process. Conclusions: This project demonstrated that a new standardized process outlined with visual workflows increased provider confidence in transferring STEMI patients. The mock scenario was found to be helpful in disseminating the new process. Several participants voiced the importance of continued education and communication between Southern Arizona Critical Access Hospital and TMC.