ST-Segment Elevation Myocardial Infarction: Door to Balloon Time Improvement Project

Area of Science:

• Cardiology
• Emergency Medicine
• Quality Improvement

Background:

• Primary percutaneous coronary intervention (PCI) is crucial for ST-segment elevation myocardial infarction (STEMI) treatment.
• Door-to-balloon (D2B) time is a critical metric for STEMI patient outcomes, with a benchmark of ≤90 minutes.
• In 2014, only 25% of STEMI patients at King Faisal Cardiac Center (KFCC) met the D2B goal.

Purpose of the Study:

• To identify causes of delay in STEMI patients requiring primary PCI.
• To implement strategies to reduce D2B time.
• To evaluate the impact of interventions on D2B times at KFCC.

Main Methods:

• Prospective data collection of STEMI patients within 24 hours of chest pain onset (January-December 2015).
• Defined process boundaries from emergency department arrival to balloon inflation during PCI.
• Utilized specific metrics to identify process defects and drive change.

Main Results:

• 54% of 37 STEMI patients achieved the target D2B time of ≤90 minutes, a significant improvement.
• Delays were attributed to late patient identification, ECG acquisition, catheterization lab activation, and transport.
• 24.4% had D2B times between 91-120 minutes, and 21.6% exceeded 120 minutes.

Conclusions:

• A 54% achievement rate for D2B time indicates a measurable improvement in STEMI care.
• Addressing delays in patient identification, ECG, lab activation, and transport is key to meeting the D2B benchmark.
• Continuous quality improvement efforts are essential for optimizing STEMI treatment pathways.