Key result
New performance processes linked to a ~43% reduction in median STEMI door-to-balloon time.
Why the study?
Reducing door-to-balloon time in patients with STEMI undergoing primary PCI is critical, but the impact of new performance processes on this time was unclear.
Do new performance processes (concurrent activation, direct phone calls, early transfer) reduce door-to-balloon time in patients with STEMI undergoing primary PCI?
Observational (n=139)
Do new performance processes (concurrent activation, direct phone calls, early transfer) reduce door-to-balloon time in patients with STEMI undergoing primary PCI?
Absolute Event Rate: 76% vs 133%
p-value: p=<.0001
Implementing concurrent emergency department activation, direct phone calls, and early catheterization laboratory transfer significantly reduces door-to-balloon time and increases the proportion of STEMI patients treated within the 90-minute guideline window.
May support streamlined STEMI activation; hypothesis-generating and requires prospective validation before practice change.
The aim of this study was to determine whether the adoption of new performance processes reduced the door-to-balloon time for primary percutaneous coronary intervention (PCI). To reduce the door-to-balloon time, we adopted 3 new performance processes: concurrent activation at the emergency department rather than stepwise activation; direct phone call rather than using a pager or message; patient transferred to catheterization laboratory before the PCI team arrive. A total of 139 consecutive patients were compared before and after the new performance processes. After the adoption of the new processes, median door-to-balloon time reduced significantly from 133 to 76 minutes (P < .0001) and patients undergoing primary PCI within 90 minutes increased significantly from 16% to 72% (P < .0001). Among the subdivisions of the door-to-balloon time, door-to-consent time and door-to-laboratory arrival time decreased significantly (50.0 vs 20.5 minutes, P < .0001; 95.0 vs 40.0 minutes, P < .0001, respectively).
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Nam et al. (2010) conducted an observational in ST-segment Elevation Myocardial Infarction (n=139). New performance processes (concurrent ED activation, direct phone call, early cath lab transfer) vs. Before adoption of new performance processes was evaluated on Median door-to-balloon time (minutes) (p=<.0001). The adoption of new performance processes significantly reduced median door-to-balloon time from 133 to 76 minutes (P < .0001) in patients with STEMI undergoing primary PCI.
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