Effectiveness of a myocardial infarction protocol in reducing door-to-ballon time
Luis Cláudio Lemos Correia1, Mariana Brito, Felipe Kalil
1Hospital São Rafael, Salvador, BA, Brazil. lccorreia@cardiol.br
Insights
Implementing a quality of care protocol significantly reduced door-to-balloon times for primary angioplasty patients. This improvement is crucial for translating angioplasty efficacy into real-world effectiveness in treating myocardial infarction.
Area of Science:
- Cardiology
- Healthcare Quality Improvement
- Interventional Cardiology
Background:
- Door-to-balloon time is critical for primary angioplasty effectiveness in myocardial infarction.
- Timely intervention ensures optimal patient outcomes.
- A target time of <120 minutes is essential.
Purpose of the Study:
- To evaluate the effectiveness of a quality improvement protocol.
- To reduce door-to-balloon times in primary angioplasty.
- To enhance the translation of angioplasty efficacy into clinical effectiveness.
Main Methods:
- Analysis of 50 patients undergoing primary angioplasty (May 2010-August 2012).
- Electronic recording of door time upon emergency room arrival.
- Definition of balloon time as the start of artery opening.
- Implementation of a protocol including a flowchart, team awareness, and feedback.
- Pre-protocol data served as baseline for comparison.
Main Results:
- Initial door-to-balloon time was 200 ± 77 minutes before protocol implementation.
- Post-protocol times showed progressive reduction: 142±78, 150±50, 131±37, and 116±29 minutes.
- Linear regression indicated a significant time reduction (r = -0.41, coefficient = -1.74 minutes/patient).
Conclusions:
- The quality of care protocol was effective in reducing door-to-balloon time.
- Protocol implementation demonstrates a positive impact on patient care efficiency.
- Shorter door-to-balloon times improve primary angioplasty outcomes.
Background:
An adequate door-to-balloon time (<120 minutes) is the necessary condition for the efficacy of primary angioplasty in infarction to translate into effectiveness.
Objective:
To describe the effectiveness of a quality of care protocol in reducing the door-to-balloon time.
Methods:
Between May 2010 and August 2012, all individuals undergoing primary angioplasty in our hospital were analyzed. The door time was electronically recorded at the moment the patient took a number to be evaluated in the emergency room, which occurred prior to filling the check-in forms and to the triage. The balloon time was defined as the beginning of artery opening (introduction of the first device). The first 5 months of monitoring corresponded to the period of pre-implementation of the protocol. The protocol comprised the definition of a flowchart of actions from patient arrival at the hospital, the team's awareness raising in relation to the prioritization of time, and provision of a periodic feedback on the results and possible inadequacies.
Results:
A total of 50 individuals were assessed. They were divided into five groups of 10 sequential patients (one group pre- and four groups post-protocol). The door-to-balloon time regarding the 10 cases recorded before protocol implementation was 200 ± 77 minutes. After protocol implementation, there was a progressive reduction of the door-to-balloon time to 142±78 minutes in the first 10 patients, then to 150±50 minutes, 131±37 minutes and, finally, 116±29 minutes in the three sequential groups of 10 patients, respectively. Linear regression between sequential patients and the door-to-balloon time (r = - 0.41) showed a regression coefficient of - 1.74 minutes.
Conclusion:
The protocol implementation proved effective in the reduction of the door-to-balloon time.
