Door to balloon times: streamlining admission for primary percutaneous coronary intervention

Primary angioplasty is superior to thrombolysis in ST elevation myocardial infarction (STEMI). This advantage is dependent on how quickly angioplasty can be performed. Several strategies have been suggested to cut door to balloon (D2B) times. We aimed to audit and reorganise the admission process to accelerate D2B times, in Waikato Hospital, New Zealand.

The admission process for STEMI was audited. Three changes were made. One step in the catheterisation lab activation system (referral to cardiology registrar on call) was removed. Single call pager activation of the catheterisation lab team was adopted. Feedback of timing performance data by email and printout was established. Timing data were collected for 6 months before and after these changes.

After the admission process was changed 88.5% of patients had a D2B time <90 min vs 63.6% before. Median D2B times were reduced from 74.5 min to 59 min (p=0.09). Median time from admission to arrival at cath lab was reduced from 50 min to 35 min (p=0.019).

Relatively minor changes in admission process, without new resources, can lead to reductions in door to balloon times. This was achieved in a hospital with a selective PPCI policy and modest annual volume of PPCI.