Implementation of multiple strategies for improved door-to-balloon time in patients with ST-segment elevation myocardial infarction

Heart Vessels. 2014 Mar;29(2):142-8. doi: 10.1007/s00380-013-0336-z. Epub 2013 Mar 19.

Abstract

Several strategies have been found to be associated with a significant reduction in door-to-balloon (D2B) time in the management of ST-segment elevation myocardial infarction (STEMI). The objective of this retrospective cohort study was to assess D2B time before and after specific hospital strategies, including a computerized provider order entry (CPOE), were implemented to reduce D2B time. Patients who presented to the emergency department within 12 h of STEMI were enrolled. Strategies adopted included: (1) electrocardiography during triage for patients with chest pain; (2) implementing a CPOE; (3) activating the catheterization laboratory by sending a cell phone notification via the computer system; (4) using an open real-time on-line STEMI registry; and (5) conducting a monthly meeting to review registration. A total of 134 patients were included in the study (preintervention, n = 69; postintervention, n = 65). Median D2B time improved from 83 to 63 min after the new strategies were implemented (P = 0.001). Median door-to-electrocardiogram (5-2 min) and door-to-laboratory time (60-41 min) also significantly improved (P < 0.001). The proportion of patients with a D2B time within 90 min increased from 59.4 % to 98.5 % (P < 0.001). In conclusion, our findings suggest that implementing specific strategies can substantially improve D2B time for patients with STEMI and increase the proportion of patients with D2B time less than 90 min.

MeSH terms

  • Aged
  • Critical Pathways
  • Electrocardiography
  • Emergency Service, Hospital
  • Female
  • Humans
  • Male
  • Medical Order Entry Systems
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / therapy*
  • Outcome and Process Assessment, Health Care*
  • Percutaneous Coronary Intervention*
  • Predictive Value of Tests
  • Registries
  • Retrospective Studies
  • Time Factors
  • Time-to-Treatment*
  • Treatment Outcome
  • Triage