Abstract 16050: Regional System to Optimize Door-to-Balloon Times in Patients Transferred for Primary Percutaneous Coronary Intervention
INTRO: Rapid reperfusion for ST-elevation myocardial infarction (STEMI) is often delayed in patients transferred for primary percutaneous coronary intervention (PCI). We report our institutional results comparing hospitals that did or did not participate in a program aimed at improving system door-to-balloon (D2B) times.
METHOD: The rapid STEMI transfer program was a collaborative effort between Emergency Medicine, local EMS, and Cardiology. This initiative focused on rapid diagnosis, initiation of transfer by referring ED, streamlining EMS transport, and optimization in cath lab. Transfers from 10 participating and 17 non-participating hospitals to UPMC-Presbyterian Hospital from May 2011 thru May 2012 after the initiation of the rapid STEMI protocol were compared to transfers between January 2009 and April 2011, before the program was in place.
RESULT: Prior to implementation, 112 patients were transferred for primary PCI, 72% from participating hospitals, with 59% from greater than 50 miles. Afterwards, 72 patients were transferred, 79% from participating hospitals, with 47% from greater than 50 miles. D2B times decreased significantly for participating hospitals after program implementation [table1]. Transfer process was divided into door-in to door-out at referring hospital (DIDO), transport time, and arrival at PCI site to balloon/aspiration. At participating hospitals, largest impact was improving DIDO (77 to 49 min, p<0.001) and PCI times (34 to 24min, p<0.001), while transport time did not change (36 to 34 min, p=0.7). Nonsignificant trend towards lower in-hospital mortality (4.4% to 1.4%) with program implementation.
CONCLUSION: Initiation of a rapid regional transfer program significantly improved D2B times, even in the first year of implementation. The greatest savings occurred through process improvements at the referring facility. Our results emphasize the importance of a pre-defined rapid transfer system at community hospitals.
- © 2012 by American Heart Association, Inc.