Reducing door-to-needle time: Treatment delay versus presentation delay

One of the primary goals of the current American College of Cardiology/American Heart Association guidelines for treating patients with AMI is reduction of treatment delay. Delays consist of three phases: time from onset of symptoms to call for help, prehospital care and transportation, and door-to-treatment time. In turn, door-to-treatment time, the delay probably most amenable to change, consists of three distinct intervals: door-to-data, or diagnosis; data-to-decision (which therapy); and decision-to-drug administration. Care should be initiated in the emergency department (ED). Along with ready accessibility of electrocardiograms, interdepartmental protocols that facilitate diagnosis in the ED have been shown to reduce the door-to-data delay. Systems that expedite the exceptional cardiologist consult help speed the time to decision. Along with standing orders for standard care, orally obtained informed consent and availability of the drug in the ED can substantially decrease delay in drug delivery. By reducing unnecessary delays, standardization of protocols for diagnosing and treating patients with AMI in the ED may substantially decrease mortality and morbidity.