Stroke and ST-Segment Elevation Myocardial Infarction Care in Rural North Idaho

Abstract

Background: Rural communities exhibit disproportionately high mortality rates, particularly due to chronic health conditions, strokes, and ST-segment myocardial infarctions (STEMI). Contributing factors include geographical barriers, limited access to specialist services, and minimal exposure to such cases. In North Central Idaho, St. Mary’s Health, a critical access hospital, serves a predominantly aging population and is located over an hour from the nearest percutaneous coronary intervention (PCI) or stroke-capable facility. These delays in recognizing clinical conditions or activating appropriate clinical pathways adversely affect patient outcomes. Purpose: The purpose of this quality improvement initiative was to enhance the knowledge and confidence of emergency room and prehospital personnel regarding stroke and STEMI protocols at St. Mary's Health, utilizing simulation-based educational methods. Methods: Guided by the Institute for Healthcare Improvement’s Plan-Do-Study-Act (PDSA) framework, simulation sessions were utilized to mock stroke and STEMI cases, followed by targeted education and facilitated debriefings. Pre- and post-intervention surveys assessed staff knowledge and confidence in recognizing symptoms and implementing protocols. Quantitative data were analyzed using paired t-tests and descriptive statistics. Results: Seven participants completed both the pre- and post-surveys, while eleven participants completed at least some portion of the survey. Confidence in recognizing acute stroke symptoms increased by 200% (p=0.008), and confidence in identifying a STEMI increased by 600% (p<0.001). There was unanimous support for continuing simulations, with limited exposure to cases identified as the primary barrier to knowledge acquisition. Conclusions: Simulation-based education significantly enhanced staff confidence and competence in managing time-critical emergencies within rural settings. Regularly scheduled simulation sessions support continuous professional development and have the potential to reduce door-to-needle and door-to-balloon times, thereby improving patient outcomes. Expanding this program to additional rural hospitals in Idaho could further mitigate disparities in emergent stroke and STEMI care between urban and rural populations.