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The effect of direct communication between emergency physicians and interventional cardiologists on door to balloon

Min-Ji Kwak1, Kyuseok Kim, Joong Eui Rhee

  • 1Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.

Journal of Korean Medical Science
|August 30, 2008
PubMed

Insights

Implementing a protocol for direct emergency physician notification of interventional cardiologists significantly reduced door-to-balloon times for ST-segment elevation myocardial infarction (STEMI) patients, improving timely treatment. This change enhanced patient care without negatively impacting other clinical outcomes.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Healthcare Management

Background:

  • ST-segment elevation myocardial infarction (STEMI) requires rapid reperfusion therapy.
  • Door-to-balloon time (DTBT) is a critical metric for STEMI treatment success.
  • Current protocols may have delays in activating interventional cardiology teams.

Purpose of the Study:

  • To evaluate the impact of a new institutional protocol on DTBT in STEMI patients.
  • To determine if direct notification by emergency physicians reduces treatment delays.
  • To assess the effect of the protocol on other clinical outcomes.

Main Methods:

  • Development and implementation of an institutional protocol.
  • Mandating direct communication between emergency physicians and interventional cardiologists for all STEMI cases.
  • Retrospective analysis of 208 STEMI patients treated with primary percutaneous coronary intervention (PCI) before (n=144) and after (n=64) protocol implementation.

Main Results:

  • Significant reduction in mean DTBT from 148±101 minutes to 108±56 minutes (p<0.05).
  • Increased proportion of patients receiving PCI within 90 minutes from 25% to 50% (p<0.05).
  • No significant differences observed in postprocedural TIMI flow, mortality, stroke, heart failure, shock, reinfarction, or length of stay.

Conclusions:

  • Mandating direct notification of interventional cardiologists by emergency physicians is an effective strategy to reduce DTBT in STEMI patients.
  • The protocol improves the timeliness of primary PCI.
  • The protocol enhances STEMI care without compromising other critical patient outcomes.

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