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March 1, 2009Circulation Cardiovascular Quality and OutcomesOpen Access

Systems-Based Improvement in Door-to-Balloon Times at a Large Urban Teaching Hospital

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Key result

Implementation of a 4-strategy quality improvement protocol significantly reduced median door-to-balloon time for STEMI patients from 125 minutes to 86 minutes (P<0.0001).

Why the study?

Do systems-based quality improvement strategies reduce door-to-balloon time in STEMI patients?

Population

243 STEMI patients at a large urban teaching hospital

Comparison

Implementation of 4 quality improvement… vs Previous STEMI protocol (historical control)

Design

Cohort

Authors

SPShailja V. ParikhDTD. Brent TreichlerSDSheila DePaola

Discussion

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Overview

May support 4-strategy QI adoption to meet <90-min D2B targets; extends observational data but leaves causality open.

Study Design

Type

Cohort (n=243)

Multicenter

No

Structured PICO

Do systems-based quality improvement strategies reduce door-to-balloon time in STEMI patients?

P
Population
243 consecutive STEMI patients treated at a large urban teaching hospital, comparing 59 patients under a new quality improvement protocol to 184 historical controls.
E
Exposure
Implementation of 4 quality improvement strategies: (1) emergency department physician activation of the STEMI protocol; (2) 'single call' broadcast paging of the STEMI team; (3) immediate feedback to emergency and cardiology departments with joint monthly meetings; and (4) transfer of off-hours STEMI patients directly to the laboratory on activation
C
Comparator
Previous STEMI protocol (historical control)
O
Outcome
Door-to-balloon time (DBT)

Main Result

Absolute Event Rate: 86% vs 125%

p-value: p=<0.0001

Implementing targeted systems-based quality improvement strategies significantly reduced median door-to-balloon times for STEMI patients, achieving the guideline-recommended target of <90 minutes.

Cite This Study

Parikh et al. (2009) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=243). 4-strategy quality improvement protocol vs. Previous STEMI protocol was evaluated on Median door-to-balloon time (DBT) (p=<0.0001). Implementation of a 4-strategy quality improvement protocol significantly reduced median door-to-balloon time for STEMI patients from 125 minutes to 86 minutes (P<0.0001).

synapsesocial.com/papers/6a82e3e2abc87fc4bf1e2368https://doi.org/10.1161/circoutcomes.108.820134
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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