91ÊÓƵ

Duke Clinical Research Institute, in collaboration with the 91ÊÓƵ led and conducted the Regional Systems Accelerator I and II Projects. These two studies, conducted independent of one another, focus on the implementation of The 91ÊÓƵ’s Mission: Lifeline program in regions of high population and with complex components of a STEMI System of Care.

ACC/AHA STEMI Guidelines include Class I recommendation that “all communities should create and maintain a regional system of STEMI care that includes assessment and continuous quality improvement of EMS and hospital-based activities.” Both Accelerator projects sought to achieve guideline-based STEMI care through intensive implementation of Mission: Lifeline.

Mission: Lifeline STEMI Accelerator I and II Project Program Goals and Objectives:

1. Markedly accelerate development and improvement of regional STEMI Systems of Care by:
• Identifying strong regional systems of care champion(s)
• Forming strong, self-sustaining regional Mission: Lifeline Task Force(s)
• Regional diagnostic protocols
• Regional treatment protocols
• Uniform data collection
• Prompt and consistent data feedback
2. Build on the Accelerator I Project to create regional response to STEMI emergency care in a timely, coordinated and consistent manner including EMS FMC to device within 90 minutes or Arrival at STEMI referring hospital to PCI within 120 minutes, for those patients not receiving fibrinolytic therapy and transferring for Primary PCI.
3. Establish regional leadership in emergency cardiac care that includes passionate and respected thought leaders to include physicians, nurses, administrators, and public health officials representing hospitals emergency medicine, cardiology, and EMS. The leaders would build consensus regarding regional solutions to coordinated care and form a regional executive leadership team.
4. Implement, monitor and maintain the intervention through partnerships between local stakeholder organizations, regional AHA leadership and national experts. (Physician leaders of hospitals, EMS agencies, and regions may establish these partnerships through a memorandum of cooperation (MOC) between individual institutions, agencies and systems to create regional quality improvement teams.

Mission: Lifeline STEMI Accelerator Program Metrics/Regional and Hospital Targets

• 75% or more of STEMI Receiving Centers in the region participating in the project to enroll in Mission: Lifeline data platform, submit STEMI data and participate in Mission: Lifeline Regional Reports
• Show positive improvement trends in regional performance for metrics included below:
• EMS FMC to PCI within 90 minutes
• Arrival at STEMI Referring Hospital to PCI within 120 Minutes
• Overall key processes and clinical outcomes

Mission: Lifeline STEMI Accelerator Project Conclusions

1. The Mission: Lifeline STEMI Systems Accelerator demonstration project represents the largest national effort to organize regional STEMI care. By focusing on first medical contact-to-device time, coordinated treatment protocols, and regional data collection and reporting, the proportion of patients treated within guideline goals was increased.
   Source:
2. Organization of care among EMS and hospitals in 12 regions was associated with significant reductions in time of reperfusion in patients with STEMI, and in-hospital mortality. These findings support a more intensive regional approach to emergency care for patients.
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Mission: Lifeline STEMI Accelerator I and II Publications

Additional Mission: Lifeline STEMI Accelerator I and II Resources

• Final Results: Mission: Lifeline STEMI Accelerator I Demonstration Project(link opens in new window)

To learn how you can participate in regionalizing Mission: Lifeline STEMI Systems of Care complete the form. An AHA Quality and Systems Improvement team member will contact you within 48 hours.