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Improving Door-In-Door-Out Times for STEMI Transfer Patients: Impact of a Protocolized Autolaunch Process
Hashim Zaidi1, Waleed Kayani2, Eric Power1
1Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston), Houston, Texas, USA.
Insights
Implementing an Autolaunch protocol significantly reduced door-in-door-out (DIDO) times for ST-segment elevation myocardial infarction (STEMI) patients. This quality improvement initiative improved transfer efficiency and patient outcomes.
Area of Science:
- Cardiology
- Quality Improvement Science
Background:
- Timely transfer of ST-segment elevation myocardial infarction (STEMI) patients to percutaneous coronary intervention-capable centers is crucial for optimal outcomes.
- National compliance with the American Heart Association's ≤30-minute door-in-door-out (DIDO) time benchmark for STEMI transfers remains suboptimal.
Background:
The timely transfer of patients with ST-segment elevation myocardial infarction (STEMI) to percutaneous coronary intervention-capable centers is critical for improving outcomes. Although the American Heart Association recommends a door-in-door-out (DIDO) time of ≤30 minutes, national compliance remains low.
Project Rationale:
At Harris Health, no patients with STEMI met this benchmark before 2022. We implemented a quality improvement (QI) initiative, including an "Autolaunch" process, to expedite STEMI transfers.
Project Summary:
During 2022-2023, we introduced QI initiatives, including the Autolaunch protocol, for patients with unequivocal STEMI. This process included rapid emergency medical services activation, direct catheterization laboratory transfer, and prearrival cardiologist notification. Data were analyzed to assess DIDO times. Before intervention, the median DIDO time was 81 minutes, with 0% of patients meeting the ≤30-minute goal. Postimplementation, the DIDO time decreased to 41 minutes, and compliance reached 39.5%. In Autolaunch cases (n = 35), the median DIDO time was 26 minutes, and the compliance was 74.3%.
Take-Home Messages:
The STEMI Autolaunch process significantly improved DIDO times. This protocolized approach may serve as a model for optimizing STEMI transfer efficiency and improving patient outcomes.
