Emergency Care in Rural Areas

Coosa Valley Medical Center is an independent community hospital located in Sylacauga, Alabama. Our facility consists of 168 inpatient beds and sees approximately 25,000 ED patients annually. A few years ago, the challenge of inconsistencies in rural STEMI care came to our attention.

The challenges rural residents face related to cardiac disease are well documented. As in many rural communities, the availability of EMS resources, both trucks and personnel, plays a vital role in the outcomes of cardiac patients. While the available resources do not necessarily mirror those of tertiary care facilities, the expectations for patient care and high-quality outcomes absolutely do.

Using the Plan Do Check Act (PDCA) approach, our first step was collecting baseline data for STEMI care in our ED. The data highlighted opportunities for improvement. The top priorities on the list of opportunities were door-to-EKG times and door-in-door-out (DIDO) times. We then assembled a multidisciplinary team to drive results as guided by the American Heart Association's National Guidelines. 

The team’s first step was providing education to ensure everyone understood the goals and expectations of the project. We conducted STEMI-focused classes on campus that included the staff of our local EMS and fire departments. The classes focused on the importance of early recognition and EKG interpretation for cardiac patients. Our cardiac nurse practitioner played a pivotal role in not only providing guidance for EKG interpretation but also coordinating efforts between CVMC, EMS, and the receiving facility. We collaborated with our local EMS agencies to implement a tiered transportation plan. 

Finally, we worked with the receiving facility to implement a single-call activation system for STEMI patients. This system allows patients to be transferred directly from the CVMC ED to the receiving facility’s cath lab.

The inconsistencies discovered in the initial data review highlighted the opportunity for standardization of processes. Standardization efforts included when and where EKGs are performed in the emergency department, the addition of ‘Code STEMI’ to overhead paging, and EMS response when a STEMI is paged out. Through these efforts, we’ve been able to reduce our door to EKG time by 48 percent. Furthermore, our DIDO has improved by 66 percent.

It has now been over two years since the project's inception. Our multidisciplinary team continues to monitor STEMI care on a case-by-case basis. Given the healthcare labor challenges the industry faces nationally, education and re-education have proven key in reducing variations in care. We are very proud of the work that has been done and the quantified improvements realized as a result thereof; however, nothing means more than knowing the value of saving one life, impacting one family, and delivering care that our community can trust in and be proud of.