In the appropriate clinical scenario, a local caregiver directly contacted the interventional cardiologist at the PCI-capable hospital with the use of the CHap. Using the application, the care team

briefly presented the case and showed the electrocardiogram to the interventional cardiologist on call. (Fig. 2) Based on this interaction, both parties would then decide on the best management approach, which could include the activation of the catheterization laboratory for possible primary PCI or an elective inter-hospital transfer for subsequent observation AUY-922 research buy or non-emergent PCI. When activation of the catheterization laboratory was considered appropriate, the on-call interventionalist activated the catheterization laboratory by contacting a central number where an expediter mobilized the entire team, and coordinated the transfer in the ZD1839 order cases initiated at other institutions. After implementation of the CHap, all interactions using the system were recorded, and there were no exclusions. The interactions regarding a possible ACS were archived and subsequently matched to our institution’s ongoing

database of catheterization laboratory activations. Matching involved date of intervention, timing of call, referral site, interventionalist involved, and interventional outcome. In addition, the accuracy of the matching details was confirmed against hospital admission and referral databases as well as quality databases at MedStar Washington Hospital Center and the MedStar Health Research Institute. CHap-generated activations were compared to those utilizing standard channels of activation over the same time period. Of note, although the use of CHap was widely encouraged, previously established channels

of activation persisted concomitantly and were more frequently used, especially during PAK6 the initial months after deployment. Primary source documents for all events were obtained and used to adjudicate STEMI cases. Adjudications were performed by physicians unaware of the activation system utilized during a particular case. Quality measures pertaining to STEMI management and system performance were adjudicated by a centralized dedicated team not involved in the study. The institutional review boards of MedStar Washington Hospital Center and the MedStar Health Research Institute (Washington, DC) approved this study. Experienced staff at a dedicated data-coordinating center performed all clinical data collection, entry, and analysis. Data regarding baseline clinical and procedural data, together with post-procedure inpatient events, were obtained from hospital chart review. Electrocardiographic criteria defining a STEMI included the presence of at least 1 mm of ST-segment elevation in at least two contiguous leads, or the occurrence of a new left bundle branch block.