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Achieving sustainable first door-to-balloon times of 90 minutes for regional transfer ST-segment elevation myocardial
B Hadley Wilson1, Angela D Humphrey, John C Cedarholm
1Sanger Heart & Vascular Institute, Carolinas Medical Center, Charlotte, North Carolina.
Insights
Implementing a STEMI network program significantly reduced first door-to-balloon times for percutaneous coronary intervention. This system-wide approach achieved sustained door-to-balloon times under 90 minutes for ST-elevation myocardial infarction patients.
Area of Science:
- Cardiology
- Health Systems Research
- Emergency Medicine
Background:
- Nationally, achieving timely percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) patients transferred from referral centers remains a challenge.
- A minority of STEMI patients achieve first door-to-balloon (1st D2B) times under 2 hours, with even fewer meeting the 90-minute benchmark.
Purpose of the Study:
- To evaluate the effectiveness of a network approach in reducing door-to-balloon times for STEMI patients.
- To assess the sustainability of achieving first door-to-balloon times within 90 minutes through a structured transfer system.
Main Methods:
- A comparative analysis of 101 STEMI transfer patients from 2007 versus 442 patients from 2008-2011 after implementing network initiatives.
- Initiatives included: established referral system, goal-oriented protocols, expedited transport, pre-activated PCI lab, and web-based feedback.
Main Results:
- Median first door-to-balloon (1st D2B) time decreased from 109.5 to 88.0 minutes (p < 0.0001).
- The percentage of patients achieving 1st D2B <90 minutes increased from 22.8% to 55.9% (p < 0.0001).
- PCI hospital door-to-balloon time decreased significantly, while transport times remained consistent. Length of stay and in-hospital mortality were low.
Conclusions:
- A system-wide network program can achieve sustained first door-to-balloon times under 90 minutes for STEMI patients.
- The implemented initiatives effectively improved the efficiency of STEMI patient transfer and treatment.
Objectives:
A network approach to transfer ST-segment elevation myocardial infarction (STEMI) patients can achieve durable first door-to-balloon times (1st D2B) for percutaneous coronary intervention (PCI) within 90 min.
Background:
Nationally, a minority of STEMI patients from referral centers obtain 1st D2B in <2 h and even fewer in <90 min.
Methods:
Included were transfer STEMI patients from 9 network hospitals treated in 2007 compared with 2008 to 2011 after installing the following initiatives: 1) established hospital referral system; 2) goal-oriented performance protocols; 3) expedited transport by ground or air; 4) first hospital activation of the PCI hospital catheterization laboratory; and 5) outreach coordinator and patient-level web-based feedback to the referring hospital.
Results:
A total of 101 STEMI patients transported in 2007 were compared with 442 STEMI patients transferred after starting these initiatives for STEMI from 2008 to 2011, with the median door-in to door-out time decreased from 44 to 35 min (p < 0.0001), the median 1st D2B decreasing from 109.5 to 88.0 min (p < 0.0001), and the percentage under 90 min increased from 22.8% to 55.9% (p < 0.0001). Overall, throughout the study period (2007 to 2011), the transport times remained consistent (median 36.5 vs. 36.0 min, p = 0.98), whereas the PCI hospital D2B decreased from 20.0 to 16.0 min (p < 0.0001). Length of stay and in-hospital mortality remained low at 3.0 days and under 4%, respectively.
Conclusions:
A system-wide network program can achieve sustained (over 4 years) 1st D2B times of <90 min.
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