Thank you for viewing the chest pain MI registry case scenario for November of 2022, where we will discuss metric 37 first medical contact to device time. A 74-year-old male experienced severe chest pain and shortness of breath after eating his lunch. His wife called 911. EMS arrived at the patient's side at 2 p.m. and transported the patient to the closest facility less than five minutes away. An ECG was performed at 2.02 p.m., but it was negative for STEMI. EMS alerted the facility based on the presentation. Upon arrival at the ED at 2.05 p.m., the ED physician reviewed the EMS ECG and requested the ECG be repeated. It was performed at 2.07 p.m. After a quick examination, including the reading of the ED ECG, the on-call cardiologist was alerted at 2.08 p.m. Code heart was activated at 2.09. The patient was transferred to the cardiac cath lab. The occluded artery was identified, and the first inflation of the balloon was performed at 2.59 p.m. Our first question is, is this patient included in the numerator of metric 37, first medical contact to device time? Number one, no, or number two, yes. Please take a moment to review the documentation before making your selection. And the answer is number two, yes. The patient meets the numerator of metric 37, first medical contact to device time for this facility. Our second question, what is the first medical contact to device time in this scenario? Is it number one, 59 minutes, number two, 52 minutes, number three, 54 minutes, or number four, unknown? We'll allow a few more minutes to go ahead and review the documentation before making your final selection. And the answer is number two, 52 minutes. Let us review the rationale as to why the correct answer is number two. Metric 37, first medical contact to device time, will calculate the time based on the following algorithm. Patients whose time for EMS first medical contact or arrival or first ECG positive for STEMI to first device activation was less than 90 minutes. When the initial ECG is STEMI or STEMI equivalent, it is performed by EMS before the patient arrived to the facility. Then the algorithm will use the EMS first medical contact date and time to calculate the time to the first device activation date and time. When the initial ECG is STEMI or STEMI equivalent, it is performed by the facility after the patient arrived. Then the algorithm will use the arrival date and time to calculate the time to the first device activation date and time. In this scenario, when the initial ECG is negative for STEMI, then the algorithm will use the date and time of the first ECG that is STEMI or STEMI equivalent, repeated subsequent ECG, whether it is pre-arrival or after arrival to the facility, 12-2-7-8, to calculate the time to first device activation date and time. The Chest Pain MI Registry has added a new column in the drill down for metric 37. Select the patient detail drill down function. The metric drill down with a column title of numerator effective start date and time is going to assist in understanding how the algorithm is calculated. Thank you for viewing the Chest Pain MI Registry November 2022 case scenario.

chest pain

shortness of breath

STEMI

ECG

EMS