ST-Segment Elevation Myocardial Infarction: Door to Balloon Time Improvement Project
Saad Al Bugami1, Jamilah Alrahimi2, Abdullah Almalki2
1King Saud bin Abdulaziz University for Health Sciences; King Faisal Cardiac Center, King Saud bin Abdulaziz Medical City, Jeddah, Saudi Arabia.
Insights
This study improved door-to-balloon times for ST-segment elevation myocardial infarction (STEMI) patients, with 54% achieving the benchmark. Delays were linked to patient identification, ECGs, and transport to the cardiac catheterization lab.
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.
Background:
The purpose of this quality improvement project was to evaluate prospectively the causes of delay for patients with acute ST-segment elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI) upon arrival at the emergency department (ED) and implement recommendations to reduce delays and analyze the impact of recommendations to reduce the door-to-balloon (D2B) time in a newly established cardiac center (King Faisal Cardiac Center (KFCC)). Primary PCI has developed as an effective treatment strategy for acute STEMI, the survival rate and patient outcome are however dependent on the time to treatment. The international benchmark for all programs dealing with acute coronary syndrome patients suffering from STEMI has been established as 90 minutes or less from the time the patient arrives at the hospital to the opening of the affected vessel in the cardiac catheterization laboratory "door-to-balloon time" or D2B. In KFCC during the year 2014, the STEMI, D2B time of ≤ 90 minutes was achieved in 25%.
Methods:
We conducted a single center prospective data collection for consecutive patients presenting with STEMI within 24 hours of the onset of chest pain between January 2015 and December 2015. The boundaries of the process began when the patient entered the emergency department and ended when the balloon was inflated during the PCI. Certain well-defined metrics were chosen to drive the change and identify the defect.
Results:
A total of 37 patients presented with STEMI. The number of patients who achieved the target D2B time ≤ 90 minutes was 20 (54%). Nine patients (24.4%) had D2B time between 91 and 120 minutes and eight patients (21.6%) beyond 120 minutes. The delays were due to late identifications of patients with chest pain as well as in obtaining ECG, activation and transport to the catheterization laboratory.
Conclusion:
There was a measurable improvement up to 54%. Several factors have contributed to the delays in achieving the goal standard of above 90%; these include late identifications of patients with STEMI, delays in obtaining the ECG, activation of the catheterization laboratory and delay of patients' transportation.
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