Key result
PDCA quality improvement linked to a ~64-minute reduction in STEMI door-to-wire time vs standard care.
Why the study?
Reducing door-to-wire time is critical for improving care efficiency in patients with STEMI.
Does a PDCA cycle-based quality improvement initiative reduce door-to-wire time in patients with STEMI undergoing primary PCI?
Observational (n=120)
No
Does a PDCA cycle-based quality improvement initiative reduce door-to-wire time in patients with STEMI undergoing primary PCI?
Mean Difference: -64.1 (95% CI -72.9–-55.3)
Absolute Event Rate: 60.8% vs 124.9%
p-value: p=<0.001
A PDCA cycle-based quality improvement initiative significantly reduced door-to-wire time by over 60 minutes for STEMI patients undergoing primary PCI.
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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Chen et al. (2026) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=120). Plan-Do-Check-Act (PDCA) cycle-based quality improvement (QI) initiative vs. Standard care was evaluated on Door-to-wire (D-to-W) time (MD -64.1, 95% CI -72.9 to -55.3, p=<0.001). A PDCA cycle-based quality improvement initiative reduced mean door-to-wire time compared to standard care (60.8 vs 124.9 minutes; MD -64.1; 95% CI -72.9 to -55.3; p<0.001) in STEMI patients.
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