Abstract 2069: Reducing Door-to-Balloon Times: Hospital Strategies That Work
Background Prompt reperfusion treatment is essential for patients with ST-segment elevation myocardial infarction (STEMI); however, few hospitals meet guideline recommended door-to-balloon time of ≥ 90 minutes for primary percutaneous coronary intervention. We sought to identify the hospital strategies that were significantly associated with lower door-to-balloon times.
Methods We surveyed 365 hospitals to identify hospital strategies that were correlated with lower door-to-balloon times. We used hierarchical generalized linear models and patient-level data from the Centers for Medicare & Medicaid Services to determine the association between hospital strategies and door-to-balloon time.
Results In multivariable analysis, several strategies were significantly associated with lower median door-to-balloon times. These included having emergency medicine physicians activate the catheterization laboratory (−7.8 min; Range −14.3 to −1.2; P-value =0.024), activating with a single call to a central page operator (−11.6 min; Range −19.8 to −3.5; P-value = 0.007), notifying an interventional cardiologist first after the STEMI diagnosis (−6.6 min; Range −12.6 to −0.6; P-value = 0.035), activating based on pre-hospital electrocardiograms (−15.3 min; Range −24.6 to −6.0; P-value = 0.003), expecting catheterization laboratory staff to arrive within 20 minutes after being paged (−11.2 min; Range −20.9 to −1.4; P-value = 0.019), not requiring specific numbers of staff present before initiating transport to the catheterization laboratory (−9.4 min; Range −18.4 to −0.3; P-value = 0.049), and real-time data feedback with internal staff (−11.1 min; Range −16.3 to −5.8; P-value < 0.001) and emergency medical services personnel (−6.9 min; Range −13.6 to −0.2; P-value 0.048). Having a cardiologist always on site was also significantly associated with faster median door-to-balloon times (−16.9 min; Range −28.6 to −5.2; P-value = 0.008). Despite their effectiveness, these strategies were used by a minority of hospitals.
Conclusion Our findings highlight a discrete set of effective, feasible, and currently underused strategies that hold promise for substantially improving patient care.