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National performance on door-in to door-out time among patients transferred for primary percutaneous coronary

Jeph Herrin1, Lauren E Miller, Dima F Turkmani

  • 1Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.

Archives of Internal Medicine
|November 30, 2011
PubMed

Insights

Delays in treatment for heart attack patients requiring transfer are common. Door-in to door-out (DIDO) times rarely meet the recommended 30 minutes, impacting timely percutaneous coronary intervention.

Area of Science:

  • Cardiology
  • Healthcare Management

Background:

  • ST-segment elevation acute myocardial infarction (STEMI) patients often require inter-hospital transfer for percutaneous coronary intervention (PCI).
  • Delays in treatment are frequent for these transfer patients.
  • Recommended door-in to door-out (DIDO) time for PCI transfer is under 30 minutes.

Purpose of the Study:

  • To assess national performance in DIDO times for STEMI patients.
  • To identify patient and hospital factors associated with DIDO time variations.

Main Methods:

  • Analysis of national data from 1034 hospitals involving 13,776 STEMI patients.
  • Utilized a mixed-effects multivariable model to examine DIDO time determinants.
  • Included patient characteristics (age, sex, race, contraindications) and hospital characteristics (size, region, location, case volume).

Main Results:

  • Only 9.7% of patients met the 30-minute DIDO time benchmark.
  • 31.0% of patients experienced DIDO times exceeding 90 minutes.
  • Significant delays observed for women, African Americans, patients with contraindications to fibrinolysis, and those treated at rural hospitals.

Conclusions:

  • The recommended 30-minute DIDO time is infrequently achieved for STEMI patients needing inter-hospital transfer for PCI.
  • Factors such as patient demographics and hospital characteristics significantly influence transfer delays.
Abstract

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