Impact of PDCA cycle optimization on door-to-wire time in patients with acute st-segment elevation myocardial
Xiao Chen1, Hongyan Xue2, Changqing Sun2
1Department of nursing, SINOPHARM North Hospital, Baotou City, Inner Mongolia 014030, China.
Insights
A quality improvement initiative using the Plan-Do-Check-Act cycle significantly reduced door-to-wire time for ST-segment elevation myocardial infarction patients. This optimization improved care efficiency without increasing adverse clinical events.
Area of Science:
- Cardiology
- Healthcare Quality Improvement
- Health Systems Research
Background:
- Reducing door-to-wire (D-to-W) time is crucial for enhancing patient care efficiency in ST-segment elevation myocardial infarction (STEMI).
- Chest pain centers aim to streamline treatment pathways for STEMI patients.
Purpose of the Study:
- To evaluate the impact of a Plan-Do-Check-Act (PDCA) cycle-based quality improvement (QI) initiative on D-to-W time.
- To assess the effectiveness of QI in a Chinese chest pain center setting.
Main Methods:
- A single-center, retrospective, before-and-after QI study involving 120 STEMI patients undergoing primary percutaneous coronary intervention.
- Comparison of standard care (control group, n=60) with PDCA-optimized care (intervention group, n=60).
- PDCA intervention components included process mapping, root cause analysis, staff training, standardized communication, and a dedicated applicator.
Main Results:
- Mean D-to-W time significantly decreased from 124.9 minutes (control) to 60.8 minutes (intervention) (p < 0.001).
- The ECG-to-catheterization-laboratory activation segment showed the most substantial reduction (41.2%).
- No significant differences in in-hospital mortality, acute heart failure, or reinfarction were observed between groups. Process indicators like ED bypass rate and response times improved.
Conclusions:
- The PDCA-based QI initiative effectively reduced D-to-W time by optimizing critical STEMI workflow segments.
- Further research with larger cohorts and longer follow-up is warranted to confirm clinical outcome benefits.
Background:
Reducing door-to-wire (D-to-W) time is critical for improving care efficiency in patients with ST-segment elevation myocardial infarction (STEMI).
Objectives:
This study evaluated the effect of a Plan-Do-Check-Act (PDCA) cycle-based quality improvement (QI) initiative on D-to-W time in a Chinese chest pain center.
Methods:
A single-center retrospective before-and-after QI study was conducted among 120 patients with STEMI undergoing primary percutaneous coronary intervention. The control group (n = 60) received standard care between June and July 2023, whereas the intervention group (n = 60) received PDCA-optimized care during the same seasonal period in 2024. The PDCA intervention included process mapping, root cause analysis, staff training, standardized communication, and a dedicated conductive paste applicator. The primary outcome was D-to-W time. Secondary outcomes included in-hospital clinical events and process indicators.
Results:
Mean D-to-W time decreased from 124.9 ± 29.8 minutes in the control group to 60.8 ± 15.2 minutes in the intervention group (p < 0.001), with an adjusted mean difference of -64.1 minutes (95% CI: -72.9 to -55.3). The ECG-to-catheterization-laboratory activation segment contributed most to the reduction (41.2%). In-hospital mortality, acute heart failure, and reinfarction did not differ significantly between groups. Process indicators, including ED bypass rate and WeChat response time, improved significantly.
Conclusion:
The PDCA-based QI initiative substantially reduced D-to-W time by optimizing key STEMI workflow segments. Larger studies with longer follow-up are needed to assess clinical outcome benefits.
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