Abstract 1997: Reduced Door-to-Balloon Time in ST Elevation Myocardial Infarction as a Consequence of Formalized Data Analysis and Feedback
Background: Formalized data feedback is one strategy proposed to reduce treatment time in ST elevation myocardial infarction (STEMI). We prospectively evaluated the effect of systematic data analysis and feedback on door-to-balloon time and on components of treatment time in a German semirural hospital network.
Methods: Consecutive patients presenting with STEMI over a one-year period (2006) were enrolled (n=114). The 3-hospital network included one hospital with primary percutaneous coronary intervention (PCI) capacity. Protocols were in place to ensure prompt transfer of patients with STEMI to the PCI center and to minimize time to treatment. They included obtaining and transmitting pre-hospital 12-lead ECGs, bypassing non-PCI hospitals, and bypassing the emergency room with direct transfer to the cardiac catheterization laboratory (CCL) when feasible. No changes were made to these treatment protocols during the study period. On a quarterly basis, data on time to treatment and its components, from initial patient contact to balloon inflation, were collected, presented to, and discussed with staff involved in the initial evaluation, transfer, and treatment of the patients. Comparisons between quarters were made with the Gehan and Pearson χ2 tests.
Results: The longest transport distance was 29 miles, and the longest transport time was 47 minutes. Mean (median) door-to-balloon times decreased from 63 (54) minutes during the first quarter to 47 (35), 37 (31), and 36 (26) minutes during the next 3 quarters (p<0.0001). Significant reductions were observed in the time between arrival at the PCI center and arrival in the CCL (p<0.02), and in the time from arrival in the CCL to balloon inflation (p<0.01). There was a nonsignificant increase in the proportion of patients with a transmitted 12-lead ECG (p=0.12). By contrast, the proportion of patients who bypassed the emergency room increased markedly (from 23% during the first quarter to 76% during the 4th quarter, p= 0.0023).
Conclusion: Formalized data feedback can lead to a marked reduction in door-to-balloon times for STEMI. This is in part due to changes in pre-hospital decision making (bypassing the emergency room).