Reduction in treatment times through formalized data feedback: results from a prospective multicenter study of
Karl Heinrich Scholz1, Sebastian K G Maier, Jens Jung
1Department of Cardiology, St. Bernward-Hospital, Hildesheim, Germany. prof.dr.k.scholz@bernward-khs.de
Insights
Systematic data analysis and feedback significantly reduced treatment times for ST-elevation myocardial infarction (STEMI) patients. This improvement in care also led to a better prognosis, especially for high-risk individuals receiving timely interventions.
Area of Science:
- Cardiology
- Health Services Research
- Clinical Quality Improvement
Background:
- ST-segment elevation myocardial infarction (STEMI) treatment times are critical for patient outcomes.
- Formalized data feedback mechanisms may optimize emergency cardiac care pathways.
Purpose of the Study:
- To assess the impact of systematic data analysis and standardized feedback on STEMI treatment durations.
- To evaluate the effect of these interventions on patient mortality in a multicenter setting.
Main Methods:
- A prospective multicenter trial involving 1,183 STEMI patients across primary percutaneous coronary intervention (PCI) and non-PCI hospitals.
- Collection and quarterly review of quality indicators, including contact-to-balloon and door-to-balloon times.
- Analysis of pre-hospital and in-hospital processes, such as patient pre-announcement and direct handoffs.
Main Results:
- Median door-to-balloon time decreased from 71 to 58 minutes; contact-to-balloon time reduced from 129 to 103 minutes.
- Increased direct handoffs to catheterization labs (22% to 38%) and primary transport to PCI facilities.
- Significant reduction in one-year mortality for all patients and particularly for high-risk patients (TIMI risk score ≥ 3).
Conclusions:
- Standardized data feedback effectively shortens treatment times for STEMI.
- This quality improvement strategy is associated with an improved patient prognosis, most notably in high-risk STEMI populations.
- The FITT-STEMI trial demonstrates the value of data-driven feedback in acute cardiac care.
Objectives:
This study sought to evaluate the effect of systematic data analysis and standardized feedback on treatment times and outcome in a prospective multicenter trial.
Background:
Formalized data feedback may reduce treatment times in ST-segment elevation myocardial infarction (STEMI).
Methods:
Over a 15-month period, 1,183 patients presenting with STEMI were enrolled. Six primary percutaneous coronary intervention hospitals in Germany and 29 associated nonpercutaneous coronary intervention hospitals participated. Data from patient contact to balloon inflation were collected and analyzed. Pre-defined quality indicators, including the percentage of patients with pre-announced STEMI, direct handoff in the catheterization laboratory, contact-to-balloon time <90 min, door-to-balloon time <60 min, and door-to-balloon time <30 min were discussed with staff on a quarterly basis.
Results:
Median door-to-balloon time decreased from 71 to 58 min and contact-to-balloon time from 129 to 103 min between the first and the fifth quarter (p < 0.05 for both). Contributing were shorter stays in the emergency department, more direct handoffs from ambulances to the catheterization laboratory (from 22% to 38%, p < 0.05), and a slight increase in the number of patients transported directly to the percutaneous coronary intervention facility (primary transport). One-year mortality was reduced in the total group of patients and in the subgroup of patients with primary transport (p < 0.05). The sharpest fall in mortality was observed in patients with primary transport and TIMI (Thrombolysis In Myocardial Infarction) risk score ≥ 3 (n = 521) with a decrease in 30-day mortality from 23.1% to 13.3% (p < 0.05) and in 1-year mortality from 25.6% to 16.7% (p < 0.05).
Conclusions:
Formalized data feedback is associated with a reduction in treatment times for STEMI and with an improved prognosis, which is most pronounced in high-risk patients. (Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction [FITT-STEMI]; NCT00794001).
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