Rural Outreach: Door to Thrombolytics.

BACKGROUND

St. Mary's Regional Hospital (SMRH) has a 250-mile service area that encompasses rural areas of Colorado, Utah, Wyoming, Arizona, and New Mexico. Transfers from smaller, more rural facilities account for 45% of ST-segment elevation myocardial infarction (STEMI) volumes at SMRH. "Facility A" is an independently owned, single-hospital organization in rural western Colorado that relies on SMRH for higher levels of care.

RATIONALE: Facility A utilizes thrombolytics (lytics) as first-line therapy for STEMI patients due to limited access to cardiac catheterization laboratories and extended transfer times that may not allow for immediate revascularization. Transfers from Facility A account for the largest percentage (39%) of all incoming STEMI transfers to SMRH. A 79.5-minute average door-to-thrombolytic administration time at Facility A prompted investigation by the SMRH cardiology team.

SUMMARY: To address extended door-to-thrombolytic administration times, the cardiology team at SMRH created a new transfer protocol, delineating a clear process for STEMI treatment. Within 18 months of implementation, door-to-thrombolytic administration times were reduced by 71%, with a 2024 year-end average of 23 minutes.