Date of Award

Fall 2020

Degree Type


Degree Name

Doctor of Nursing Practice (DNP)


Leadership and Advanced Nursing Practice

Committee Chair

Dr. Carolyn Coleman

Committee Chair School

Leadership and Advanced Nursing Practice

Committee Member 2

Dr. Cathy Hughes

Committee Member 2 School

Professional Nursing Practice


Heart disease is a leading cause of death in the United States (Centers for Disease Control [CDC], 2020). ST-elevation myocardial infarctions are around 38% of all coronary syndrome patients that present to the emergency department (Akbar et al., 2020). Smaller, outlying facilities can be at a disadvantage due to the lack of readily available specialties and services, such as a cardiac catheterization laboratory, which has the potential to cause a delay in inpatient care. With standardized cardiac protocols in place at many facilities, initial identification and treatment of myocardial infarctions are begun long before a patient enters a facility, often with a catheterization team waiting for the patient’s arrival. Streamlining the initiation of protocols can better improve patient outcomes and transfer times for emergency rooms to a larger receiving facility for early percutaneous coronary interventions and reperfusion of the ischemic heart muscle. The goal of the quality improvement project was early identification by the emergency room providers and initiation of more efficient transfer to reduce transfer time. A secondary aspect provided information for better training for future staff members of the emergency department.

The population of the study included patients with a diagnosis of ST-segment myocardial infarction and over the age of 18. The setting was a small rural emergency department without a cardiac catheterization laboratory in the facility. A retrospective chart review was performed to evaluate the overall door to transfer times of patients diagnosed with ST-segment elevation myocardial infarctions. The results of the chart review revealed the patients were transferred to a higher level of care within a 60-minute time frame.

Overall, the facility was below standard times of transfers to a higher level of care for myocardial infarctions. An executive summary was given to the emergency department staff director and medical director of the findings. After the executive summary was provided, the director reported the consideration of future policy implementation.