title: Cardiac cath lab activation by the emergency physician without prior consultation decreases door-to-balloon time.
abstract: OBJECTIVE
  The purpose of this before-and-after study is to determine whether an ED strategy which calls for cardiac catheterization lab (cath lab) activation directly by the emergency physician (EP) is effective in decreasing door-to-balloon time (DTBT).
  
  
  METHODS
  In our active community teaching hospital ED, with an annual census of 55,000, the traditional practice for STEMI required cardiology consultation prior to cath lab notification. In November 2003 we instituted an ED protocol which mandated direct cath lab activation by the EP for eligible STEMI patients without prior notification of the cardiologist. We measured clinically relevant time intervals, including DTBT, prior to and after institution of the protocol.
  
  
  RESULTS
  Twenty-four patients were enrolled after institution of the protocol; these were compared to twenty STEMI patients enrolled prior to the new protocol. DTBT decreased significantly, from 118 to 89 minutes, p=.039. Other ED parameters, including door to exam (17 vs. 15 minutes) and total ED time (80 vs. 56 minutes, p = .056) decreased post-protocol but were not significantly different for the two periods. Those arriving by ambulance continued to have a significantly lower DTBT than non-ambulance patients (pre: change of 47 minutes, p = .03, post: change of 33 minutes; p = .012). Both groups were affected similarly by the change in protocol, decreasing DTBT by approximately 25%.
  
  
  CONCLUSIONS
  We conclude that a strategy which mandates cath lab activation by the emergency physician for STEMI without prior cardiology consultation, reduces door to balloon time.
authors.affiliation: St. Luke's Hospital, Emergency Medicine Residency, 801 Ostrum Street, Bethlehem, PA, 18015, USA. jeannejacoby38@yahoo.com
authors.forename: Jeanne
authors.initials: J
authors.lastname: Jacoby
authors.forename: Jennifer
authors.initials: J
authors.lastname: Axelband
authors.forename: John
authors.initials: J
authors.lastname: Patterson
authors.forename: Daniel
authors.initials: D
authors.lastname: Belletti
authors.forename: Michael
authors.initials: M
authors.lastname: Heller
mesh_terms: D002404:Catheterization / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D006764:Hospitals, Community; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D010414:Pennsylvania; D012017:Referral and Consultation; D013997:Time Factors