Association Between Hospital Practices and Door-in-door-out Time in ST-segment Elevation Myocardial Infarction
Bryn E Mumma1, James Eggert, Simon A Mahler
1From the *Department of Emergency Medicine, University of California Davis, Sacramento, CA; †San Juan Bautista School of Medicine, Caguas, Puerto Rico; ‡Department of Emergency Medicine, Wake Forest Baptist Health, Winston-Salem, NC; §Division of Cardiology, Virginia Commonwealth University, Richmond, VA; and ¶Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX.
Insights
Achieving the 30-minute door-in-door-out (DIDO) goal for ST-segment elevation myocardial infarction (STEMI) transfer is challenging. System-wide quality improvement programs, not overall practice use, were linked to shorter DIDO times.
Area of Science:
- Cardiology
- Healthcare Systems Research
- Quality Improvement
Background:
- Current guidelines recommend a door-in-door-out (DIDO) time of ≤30 minutes for ST-segment elevation myocardial infarction (STEMI) patients transferred for primary percutaneous coronary intervention.
- Eighteen critical system practices were previously identified to reduce DIDO times.
Purpose of the Study:
- To assess the frequency of use of 18 critical system practices in STEMI referral hospitals.
- To determine if the use of these practices correlates with reduced DIDO times.
Main Methods:
- A survey of 18 STEMI referral hospitals and 4 STEMI-receiving centers was conducted regarding the adoption of 18 system practices.
- Univariate linear regression analysis evaluated the association between practice implementation and DIDO times for 93 STEMI patients.
Main Results:
- The median number of practices implemented was 14 (IQR 12-15).
- System-wide quality improvement programs were significantly associated with shorter DIDO times (P < 0.001).
- Overall use of system practices did not correlate with DIDO times (P = 0.143), and 76% of transfers exceeded the 30-minute goal.
Conclusions:
- Achieving the 30-minute DIDO benchmark remains difficult for STEMI transfers.
- System-wide quality improvement initiatives are crucial for optimizing DIDO times and improving patient care pathways.
Background:
Current guidelines suggest a "door-in-door-out" (DIDO) time of 30 minutes or shorter for patients with ST-segment elevation myocardial infarction (STEMI) who arrive at a STEMI referral hospital and are transferred to a STEMI-receiving center for primary percutaneous coronary intervention. Experts previously identified 18 system practices as critical for reducing DIDO times. The objective of this study was to describe how frequently these critical practices are used and to determine whether their use was associated with shorter DIDO times.
Methods:
We surveyed 18 STEMI referral hospitals for 4 STEMI-receiving centers regarding their use of these 18 practices. The median number used was 14 practices (interquartile range 12-15). We then evaluated their association with DIDO times in all patients (n = 93) transferred from these STEMI referral hospitals to the 4 STEMI-receiving centers for primary percutaneous coronary intervention.
Results:
In univariate linear regression analyses, system-wide quality improvement programs with leaders in the emergency medical services agencies and STEMI referral hospitals were associated with shorter DIDO times (P < 0.001 for all). Overall use of system practices was not associated with DIDO times (P = 0.143). The majority (76%, 95% confidence interval: 66%-85%) of DIDO times did not meet the 30-minute goal.
Conclusions:
These findings highlight the difficulty in achieving the 30-minute DIDO goal and the need for continued focus on strategies for reducing DIDO time, including system-wide quality improvement programs.
More Related Videos
09:21Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:26Cardiac Catheterization IV: Nursing Management