Achievement of a median door‐to‐balloon time of less than 90 minutes by implementation of organizational changes in the ‘Emergency Department to Cath Lab’ pathway: a 5‐year analysis

RATIONALE: At present, most patients presenting directly to emergency departments (EDs) do not meet the recommended door-to-balloon goal of less than 90 minutes for ST-elevation myocardial infarction (STEMI) patients. Until the year 2005, the goal of less than 90 minutes door-to-balloon time has been rarely achieved in our hospital (i.e. 17% of all cases). METHOD: Some organizational changes - including immediate involvement of the cardiologist in ED - were established to improve our performance. To evaluate the results of these changes, we have measured the intervals pain-to-door, door-to-electrocardiogram (ECG) and ECG-to-balloon for all the consecutive STEMI patients (n = 206) observed in our hospital during three sample months (May to July) of the years 2005 to 2009. We have then calculated the times door-to-balloon and pain-to-balloon (total ischemic time). RESULTS: We have demonstrated that the door-to-balloon time has been progressively reduced to less than 90 minutes in 73% of patients. Only 4.5% of all patients still have a door-to-balloon time greater than 150 minutes (17% in 2005). It is also notable the 60% reduction (from 330 to 140 minutes) of the pain-to-door time, the so-called 'out of hospital avoidable delay', was achieved by a sensitization campaign directed to the whole population of the province. CONCLUSION: Taken together, all these organizational changes have allowed to reduce the total ischemic time from 465 minutes in year 2005 to 232 minutes in year 2009, thereby demonstrating the effectiveness of our intervention.