Thank you for viewing the chest pain MI registry December case scenario regarding metric 37, first medical contact to device time. In this scenario, EMS responds to a 911 call from a patient complaining of chest pain and shortness of breath. Ground EMS arrives at the patient's side at 1300. An ECG reveals STEMI, and the patient's systolic blood pressure is 80 millimeters of mercury. Air EMS is called to transport the patient to the PCI capable facility. Air EMS left the scene at 1322. They arrived at the facility at 1405 and went emergently to the cath lab. The first balloon inflation was at 1433. Our question in this scenario, is this patient included in the denominator of metric 37? Is it number one, no, or number two, yes? Please take a few moments to review the documentation and the question before considering your response. The answer is number two, yes. The patient is included in the denominator of metric 37. The denominator criteria will include those patients who are pre-admitted STEMI in 12447 and receive primary PCI for acute STEMI in 12326. Therefore, the patient is included in the denominator for evaluation. Next, let's review the denominator exclusions. The denominator exclusions will remove patients transferred from outside facility in 12421 and who received thrombolytics in 12296 before device activation time in 7845. The patient was not transferred from an outside facility, nor did she receive thrombolytics prior to the PCI. Therefore, these denominator exceptions do not apply to this patient scenario. When reviewing the denominator exceptions and what is abstracted from the medical record, we see the EMS first medical contact to device time is 93 minutes. For an exception to remove the patient from the denominator, the EMS first medical contact to device time must be greater than 90 minutes. Next, let's look at each exception. Non-system reason for delay in sequence 12419 selected for such reasons as cardiac arrest, required intubation, or a patient's refusal of transport, which prevents the wheels from moving to the facility, does not apply to this scenario. EMS leaving the scene in sequence 12199 to arrival in sequence 3001 is 43 minutes. Therefore, this exception does not apply as the actual transport time must be greater than or equal to 45 minutes. There was not a patient-centered reason for delay in PCI in 7850, nor was the patient enrolled in a clinical trial related to brief perfusion therapy in 12456. Further release notes located in the dashboard, the metric 37 first medical contact to device time algorithm has been updated to accurately reflect the EMS transport time by using sequence 12199 EMS leaving scene date and time. It is no longer calculated using sequence 12197 EMS first medical contact date and time. Thank you for viewing the Chest Pain MI Registry's December case scenario regarding metric 37.

metric 37

time

medical contact

device insertion

chest pain patients