Abstract 19933: Factors Contributing to Door-In/Door-Out Delays Among ST Elevation Myocardial Infarction (STEMI) Patients Undergoing Rural Inter-hospital Transfer for Primary Coronary Intervention
Background: Inter-hospital transfer of ST elevation myocardial infarction (STEMI) pts from non-coronary intervention (PCI) capable (STEMI-referral) to PCI-capable (STEMI-accept) hospitals is limited by prolonged overall door-to-balloon (D2B) times, largely attributable to STEMI-referral hospital delays. The Door-in/Door-out (DIDO) time (STEMI-referral door-to-departure) is a metric assigning partial accountability to the STEMI-referral facility for D2B.
Methods: To identify DIDO delays, we delineated 4 individual DIDO care components among 835 consecutive pts with presumed STEMI transferred for primary PCI from 24 STEMI-referral to 3 STEMI-accepting hospitals in rural, Central/ Southern Illinois between 1/2005-12/2009. Mode of transport (air or ground) was determined on transport time ≤ 40 min, regardless of transport distance. DIDO components of care analyzed were: a) door-to-ECG, b) ECG-to-transport activation (ECG-to-call for transport), c) transport response (transport activation-to-transport arrival), and d) transport on-scene (transport arrival-to-departure).
Results: Pt arrival to STEMI-referral hospital was usually by self transport (529/835;66%). Inter-hospital air transport was required in 53% pts. DIDO time was 49(33,66) min accounting for 45% of overall D2B. The proportion of pts with a DIDO ≤ 30 min and ≤ 40 min was 20% and 38% respectively. The door-to-ECG and ECG-to-transport activation times were 5(2,9) and 9(3,18) min respectively. Transport response [15(5,29) min] and transport on-scene [13(9,18) min] times accounted for 60% of DIDO delay.
Conclusion: The DIDO interval accounted for 45% of overall D2B with few pts (20%) achieving DIDO < 30 min. While certain institutional care processes appear readily modifiable (i.e. reducing door-to-ECG time) systems-associated processes (i.e. mode of transport used) represent more preponderant challenges to achieving target D2B times within inter-hospital transfer programs.
- © 2010 by American Heart Association, Inc.