Abstract 15579: “Register and Roll”_A Novel Initiative to Improve First Door-to-Balloon Time in ST Elevation Myocardial Infarction
Objective: We sought to find the cause of delay in the transfer of patients presenting with an acute ST-segment myocardial infarction (STEMI) from non percutaneous coronary intervention (PCI) capable to PCI capable hospitals. After consideration of our findings, we implemented a novel initiative to improve the transfer and speed time between first door and balloon (D2B). Background: National guidelines call for D2B times of ≤ 90 minutes for patients presenting with STEMI undergoing PCI. In patients presenting to non-PCI capable hospitals it is met in only 8.6% of patients. Guidelines recommend every health system to implement their own methods to achieve the goal under “Lifeline Mission”.
Methods: A retrospective analysis was performed from April 2006 to February 2009 in which all STEMI patients transferred for PCI to our Heart Institute from a non-PCI capable hospital were analyzed to determine the cause of delay in the transfer. After finding the major causes of delay, we adopted the “Register and Roll” initiative, to facilitate prompt transfer of STEMI patients. This process streamlined the triage of patients at the primary hospital. Two years after implementation we conducted a second retrospective analysis from March 2009 to July 2011 of key time intervals.
Results: A total of 144 patients were included in the retrospective analyses, 74 pre-initiative and 70 post- initiative. We analyzed the different times involved in transferring the patients, including time to EKG, time to EMS activation, door in-door out, EMS transport time etc. EMS activation was a major cause of delay in the transfer. After implementation of our initiative, the EMS activation time has significantly decreased and D2B approached recommended goal. (130 min vs 93 min, p < 0.001). Of those transferred, nearly 55% of patients had 1st door to balloon times of 90 minutes or less.
Conclusion: “Register and Roll” our novel initiative involves simple guidelines, an emergency room CATH KIT and prompts EMS notification. Timely request for EMS services and door-in-door-out time have improved significantly. This initiative is simple, easily instituted and reliable in a community hospital setting where resources are limited.
- © 2012 by American Heart Association, Inc.