Achieving Sustainable First Door-to-Balloon Times of 90 Minutes for Regional Transfer ST-Segment Elevation Myocardial Infarction

• Published in: JACC. Cardiovascular interventions Vol. 6; no. 10; pp. 1064 - 1071
• Main Authors: Wilson, B. Hadley, MD, Humphrey, Angela D., MS, Cedarholm, John C., MD, Downey, William E., MD, Haber, Robert H., MD, Kowalchuk, Glen J., MD, Rinaldi, Michael J., MD, Miller, Denise A., BSN, Sarafin, Jennifer L., MSN, Garvey, J. Lee, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2013
• Subjects: Cardiovascular; Guideline Adherence; Hospital Mortality; Hospitals, University; Humans; infarction; Length of Stay; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - therapy; North Carolina; Patient Transfer - standards; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - mortality; Percutaneous Coronary Intervention - standards; Practice Guidelines as Topic; Program Evaluation; Referral and Consultation; Regional Health Planning; South Carolina; ST-segment elevation; systems of care; Time Factors; Time-to-Treatment - standards; transfer; Treatment Outcome; North Carolina; South Carolina; Acute Coronary Treatment and Intervention Outcome Network; 1st D2B; infarction; systems of care; ST-segment elevation; first door-to-balloon; DIDO; percutaneous coronary intervention; transfer; ACTION; door-in to door-out; PCI; STEMI; ST-segment elevation myocardial infarction
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2013.05.018

Objectives A network approach to transfer ST-segment elevation myocardial infarction (STEMI) patients can achieve durable first door-to-balloon times (1st D2B) for percutaneous coronary intervention (PCI) within 90 min. Background Nationally, a minority of STEMI patients from referral centers obtain 1st D2B in <2 h and even fewer in <90 min. Methods Included were transfer STEMI patients from 9 network hospitals treated in 2007 compared with 2008 to 2011 after installing the following initiatives: 1) established hospital referral system; 2) goal-oriented performance protocols; 3) expedited transport by ground or air; 4) first hospital activation of the PCI hospital catheterization laboratory; and 5) outreach coordinator and patient-level web-based feedback to the referring hospital. Results A total of 101 STEMI patients transported in 2007 were compared with 442 STEMI patients transferred after starting these initiatives for STEMI from 2008 to 2011, with the median door-in to door-out time decreased from 44 to 35 min (p < 0.0001), the median 1st D2B decreasing from 109.5 to 88.0 min (p < 0.0001), and the percentage under 90 min increased from 22.8% to 55.9% (p < 0.0001). Overall, throughout the study period (2007 to 2011), the transport times remained consistent (median 36.5 vs. 36.0 min, p = 0.98), whereas the PCI hospital D2B decreased from 20.0 to 16.0 min (p < 0.0001). Length of stay and in-hospital mortality remained low at 3.0 days and under 4%, respectively. Conclusions A system-wide network program can achieve sustained (over 4 years) 1st D2B times of <90 min.