Why the study?
Current guidelines recommend a door-in-door-out time of 30 minutes or shorter for STEMI patients transferred for primary PCI, but the frequency of critical system practices and their association with DIDO times are unclear.
Does the use of critical system practices reduce door-in-door-out time in patients with STEMI transferred for primary percutaneous coronary intervention?
Observational (n=93)
Yes
Does the use of critical system practices reduce door-in-door-out time in patients with STEMI transferred for primary percutaneous coronary intervention?
System-wide quality improvement programs are associated with shorter door-in-door-out times for STEMI transfers, though the majority of transfers still fail to meet the 30-minute guideline goal.
BACKGROUND: Current guidelines suggest a "door-in-door-out" (DIDO) time of 30 minutes or shorter for patients with ST-segment elevation myocardial infarction (STEMI) who arrive at a STEMI referral hospital and are transferred to a STEMI-receiving center for primary percutaneous coronary intervention. Experts previously identified 18 system practices as critical for reducing DIDO times. The objective of this study was to describe how frequently these critical practices are used and to determine whether their use was associated with shorter DIDO times. METHODS: We surveyed 18 STEMI referral hospitals for 4 STEMI-receiving centers regarding their use of these 18 practices. The median number used was 14 practices (interquartile range 12-15). We then evaluated their association with DIDO times in all patients (n = 93) transferred from these STEMI referral hospitals to the 4 STEMI-receiving centers for primary percutaneous coronary intervention. RESULTS: In univariate linear regression analyses, system-wide quality improvement programs with leaders in the emergency medical services agencies and STEMI referral hospitals were associated with shorter DIDO times (P < 0.001 for all). Overall use of system practices was not associated with DIDO times (P = 0.143). The majority (76%, 95% confidence interval: 66%-85%) of DIDO times did not meet the 30-minute goal. CONCLUSIONS: These findings highlight the difficulty in achieving the 30-minute DIDO goal and the need for continued focus on strategies for reducing DIDO time, including system-wide quality improvement programs.
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Mumma et al. (2016) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=93). 18 critical system practices was evaluated on Door-in-door-out (DIDO) time (p=0.143).
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