Award Date


Degree Type

Doctoral Project

Degree Name

Doctor of Nursing (ND)



First Committee Member

Paul Thomas Clements

Second Committee Member

Roseann Colosimo

Third Committee Member

Jay Shen

Number of Pages



Over 605,000 patients will suffer an ST-segment elevated myocardial infarction in the United States each year. The gold-standard definitive treatment for this is percutaneous coronary angioplasty or the ballooning open and stenting of the blockage. The American Heart Association has set the evidence-based gold standard of 90-minutes from identification of blockage to reperfusion of heart muscle. In a health system in Las Vegas, NV, this goal is frequently missed due to lack of protocols in place to expedite patients towards definitive treatment. The purpose of this evidence-based practice change is to reduce STEMI patient morbidity and mortality via a nursing intervention. The PICOT question addressed by this project is: in STEMI patients, does the use of emergency room nurse-managed protocol improve Door-to-Reperfusion time? Evidence for this practice change involves the use of protocols in hospital systems that improved reperfusion times, and the use of protocols during off hours when reperfusion times lag the most. Delays in ambulance transport were also addressed as this provides opportunities to improve EMS to ER communication and throughput. Despite this evidence, there remains a paucity of research regarding the nurse role in reducing Door-to-Reperfusion time. The clinical implications of the evidence show that creating a process or protocol will reduce Door-to-Reperfusion times and thus STEMI patient morbidity and mortality. It is therefore not a reach to infer that a nurse-driven protocol can achieve this goal and that is what this evidence-based practice change seeks to attain. Keywords: STEMI, door-to-reperfusion, nurse-managed protocol, emergency nurse, door-to-balloon


door-to-balloon; door-to-reperfusion; emergency nurse; heart attack; nurse-managed protocol; STEMI


Medical Sciences | Medicine and Health Sciences | Nursing

File Format


File Size

857 KB

Degree Grantor

University of Nevada, Las Vegas




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