Intervention Title:
Treating Patients More Quickly with the Reperfusion of Acute Myocardial Infarction (RACE) System, Duke Clinical Research Institute; Durham, N.C.

Goal:
Standardize the triage and transfer of ST segment elevation myocardial infarction (STEMI) patients, similar to the triage and transfer standardization used for trauma patients in hospitals around the country.

Innovation:
The RACE project introduced a standardized process by which each participating hospital designates a reperfusion and triage strategy for STEMI patients to decrease door-to-balloon times for percutaneous coronary intervention (PCI) in North Carolina, where only 15 of the 101 counties in the state have hospitals that perform the procedure.

Result:
The adoption of the RACE System in intervention hospitals decreased door-to-balloon time by 33 percent over a one-year period. The RACE System allowed the primary PCI centers that took part in the project to reduce their balloon time to more closely align with the Door to Balloon Alliance goal of 75 percent of patients achieving a door to balloon goal in less than 90 minutes.

Institution:
Duke Clinical Research Institute
2400 Pratt Street
Durham, NC 27705
P: (919) 684-8111

From the C-Suite:

“Some patients in our country wait hours for a transport for treatment, resulting in irreparable damage or even death. With RACE, we’ve moved to a model where hours of waiting have been reduced to minutes. This reduction in time to treatment saves heart muscle and lives.”

Mayme Lou Roettig, R.N., M.S.N.
Executive Director, RACE

Profile:
The Duke Clinical Research Institute (DCRI) is the world’s largest academic research organization, managing the aggregate state STEMI data contributed by all primary PCI centers.

Clinical areas affected:

• Emergency department

Staff involved:

• Catheterization lab staff
• Emergency department staff
• Paramedics and Emergency Medical Services (EMS) staff
• RACE coordinators and project leaders

Timeline:
The RACE System took about four years to implement statewide: 2005-2006 recruitment of 10 systems and two-thirds of acute care hospitals; 2007-2008 recruitment of all EMS and 123 acute care hospitals; 2009 data results in progress.

Contact:
Mayme Lou Roettig, R.N., M.S.N.
Executive Director, RACE
Mayme.roettig@duke.edu
P: (704) 483-9922

Innovation implementation:
Treating STEMI heart attack victims is often a challenge because hospitals are not always equipped with the staff or resources to perform the preferred method of reperfusion, primary PCI. The idea behind RACE was that by training and equipping EMS personnel on the frontlines to handle some of the diagnostic and treatment procedures traditionally performed in hospital emergency rooms, the treatment of heart attack patients could be accelerated, saving heart muscle and ultimately saving lives. In addition, it was also found to be critical that each emergency department has a reperfusion plan and is able to execute transfer in a timely manner when that is the plan.

Implementing the RACE System required the buy-in of several community stakeholders, including the administration of emergency services departments and multiple hospitals. By working with the local chapter of the American College of Cardiology, RACE System leadership were able to both contact and convene meetings with the stakeholders needed to implement the RACE System.

Groups considering the introduction of the RACE System in their areas should consider working with other local health-focused organizations, including the department of public health or a local chapter of the American Heart Association, and specialty organizations such as the American College of Emergency Physicians (ACEP), American College of Cardiology (ACC), Emergency Nurses Association (ENA), American Association of Critical-Care Nurses (AACN) and their state offices of Emergency Medical Services (EMS).

Advice and lessons learned:

1. Stakeholders must focus on the community need. Often, hospitals and community groups have competing interests that can limit progress in a change like the RACE System, where stakeholders must work together if the project is going to be successful.
2. Full-time staffing is essential to program success. Because so many stakeholders are involved, having someone—in this case, RACE coordinators, project leaders, and a state director—available full time to guide the implementation process will help to ensure success.

Cost/benefit estimate:
Length of hospital stays have decreased, and lives have undoubtedly been saved, but a full financial analysis of costs and benefits has not been completed.