Abstract P106: Using Statistical Method to Shorten Door-to-balloon Time Improves Survival of Myocardial Infarction
Background: Rapid reperfusion of infarct-related artery is essential to the prognosis of STEMI. So, we implemented an audit program to moniter the performance of Door-to-balloon (D2B) time in 2005, and a systemic quality improvement program in 2006.
Method: Since December, 2007, we have begun to use table and registration form, which were modified from the D2B allies’, and used the time-frame analysis and 6-sigma method for improvement. Such a table comprises 9 intervals (from patients’ arrival at ER to balloon-inflation in catheterization room (CR)). The process of each patient of Non-transferred STEMI (NT-STEMI) has been recorded using this table. Then, the intervals with high coefficient variance (CV) would be picked up first for scrutinizing and quality improvement in a step-by-step fashion.
Result: In the first stage, we achieved significant shortening of the interval 5 (CR ready time) and interval 6 (patient transportation from ER to CR) which have the higher CV than the rest, within 3 months (1.08 to 0.83 and 0.65 to 0.54 respectively). Then, with the same method, we turned to Interval 1 (first ECG complete time) and interval 2 (time of STEMI diagnosed) and so on. Consequently, we achieved D2B time <90 minutes in >75% of NT-STEMI in May, 2009, with significant decrease of the median of NT-STEMI-D2B (from 178.2 minutes in 2005 to 87.5 minutes in 2008). Besides, the in-hospital mortality rate of NT-STEMI patients has been improved (from 6.8% before program initiation to 4.5% in 2008) (Figure 1⇓).
Conclusion: Systemic audit program using time-frame analysis, statistical process control could shorten NT-D2B time in STEMI patients and improve their survival.