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Door-to-Needle Time in Myocardial Infarction: Small Steps, Huge Dividends

Vivek Chauhan1, Bhagwan Das Negi2, Gurudutt Sharma2

  • 1IGMC Shimla, Himachal Pradesh, India.

Indian Heart Journal
|July 9, 2019
PubMed

Insights

Implementing a fast-track protocol in the emergency department significantly reduced door-to-needle time for ST-elevation myocardial infarction (STEMI) patients. This zero-cost intervention saves critical minutes, improving outcomes for acute coronary syndrome.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Health Services Research

Background:

  • Prehospital delay in acute coronary syndrome (ACS) is a significant issue, with a Himachal Pradesh registry reporting 780 minutes.
  • Each hour of delay in door-to-needle time increases the hazard ratio of death by 20% in ST-elevation myocardial infarction (STEMI) patients.
  • Efficient emergency department (ED) protocols are crucial for timely reperfusion therapy.

Purpose of the Study:

  • To evaluate the impact of a fast-track protocol on door-to-needle time in STEMI patients.
  • To assess the cost-effectiveness and time-saving benefits of implementing a streamlined ED process.
  • To compare door-to-needle times between retrospective and prospective patient groups.

Main Methods:

  • Retrospective (group 1) and prospective (group 2) analysis of 63 STEMI patients each.
  • Implementation of a zero-cost fast-track protocol in the emergency department.
  • Measurement of door-to-needle times before and after protocol implementation.

Main Results:

  • The fast-track protocol significantly reduced door-to-needle time by 63 minutes for STEMI patients.
  • Performing thrombolysis in the ED, rather than CCU, saved an additional 33 minutes.
  • The protocol was implemented at zero cost to the hospital.

Conclusions:

  • A fast-track protocol is an effective, zero-cost strategy to reduce door-to-needle time in STEMI.
  • Streamlining ED processes for thrombolysis improves efficiency and potentially patient outcomes.
  • Reducing delays in STEMI management is critical for mitigating mortality risk.

Keywords:
Acute coronary syndromeQuality improvement

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