2022 Quality Summit ePosters (Non-CE) - General Quality Improvement-7. Clinical Care Pathway for Low-Risk ST Segment Elevation Myocardial Infarction

7. Clinical Care Pathway for Low-Risk ST Segment Elevation Myocardial Infarction

Pdf Summary

A study conducted at a tertiary care center aimed to determine if a risk-based algorithm could be implemented to triage low-risk ST segment elevation myocardial infarction (STEMI) patients to an intermediate level of care instead of the traditional intensive care unit (ICU) setting. Prior to the study, all STEMI patients were admitted to the cardiac ICU, with a median length of stay (LOS) of 3 days. The study included STEMI patients presenting between November 2018 and December 2020 and stratified them based on Zwolle risk score. The study group consisted of low-risk patients (Zwolle <=3) admitted to a stepdown unit, while the control group consisted of low-risk patients admitted to the ICU due to a lack of stepdown beds.<br /><br />The primary data point analyzed was length of stay, while secondary data points included rapid response/cardiac alerts, need for ICU-level care, major bleeding, 30-day hospital readmission, and in-hospital and 30-day mortality. The study found that implementing the risk-based algorithm resulted in a 19-hour reduction in LOS and a cost saving of $8,000 per patient stay.<br /><br />The study concluded that implementing a risk-based algorithm for triaging low-risk STEMI patients to an intermediate level of care was safe and resulted in reduced LOS and cost savings. However, it should be noted that this was a single-center, non-randomized study, and some patients admitted to the cardiac ICU with low-risk scores seemed to be sicker than those admitted to the stepdown unit. The study also noted that patients admitted to the cardiac ICU had different teams caring for them, which could have contributed to the shorter length of stay in the stepdown unit.<br /><br />In summary, this study suggests that implementing a risk-based algorithm for triaging low-risk STEMI patients can lead to improved outcomes and cost savings. However, further research is needed to validate these findings and to address the limitations of this study.

Keywords

ST segment elevation myocardial infarction

STEMI

tertiary care center

risk-based algorithm

intensive care unit

stepdown unit

Zwolle risk score

length of stay

cost savings

patient outcomes