Strategies for reducing the door-to-balloon time in acute myocardial infarction.
BACKGROUND
Prompt reperfusion treatment is essential for patients who have myocardial infarction with ST-segment elevation. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon time) during primary percutaneous coronary intervention should be 90 minutes or less. However, few hospitals meet this objective. We sought to identify hospital strategies that were significantly associated with a faster door-to-balloon time.


METHODS
We surveyed 365 hospitals to determine whether each of 28 specific strategies was in use. We used hierarchical generalized linear models and data on patients from the Centers for Medicare and Medicaid Services to determine the association between hospital strategies and the door-to-balloon time.


RESULTS
In multivariate analysis, six strategies were significantly associated with a faster door-to-balloon time. These strategies included having emergency medicine physicians activate the catheterization laboratory (mean reduction in door-to-balloon time, 8.2 minutes), having a single call to a central page operator activate the laboratory (13.8 minutes), having the emergency department activate the catheterization laboratory while the patient is en route to the hospital (15.4 minutes), expecting staff to arrive in the catheterization laboratory within 20 minutes after being paged (vs. >30 minutes) (19.3 minutes), having an attending cardiologist always on site (14.6 minutes), and having staff in the emergency department and the catheterization laboratory use real-time data feedback (8.6 minutes). Despite the effectiveness of these strategies, only a minority of hospitals surveyed were using them.


CONCLUSIONS
Several specific hospital strategies are associated with a significant reduction in the door-to-balloon time in the management of myocardial infarction with ST-segment elevation.
Bradley
Elizabeth H
EH
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA.
Herrin
Jeph
J
Wang
Yongfei
Y
Barton
Barbara A
BA
Webster
Tashonna R
TR
Mattera
Jennifer A
JA
Roumanis
Sarah A
SA
Curtis
Jeptha P
JP
Nallamothu
Brahmajee K
BK
Magid
David J
DJ
McNamara
Robert L
RL
Parkosewich
Janet
J
Loeb
Jerod M
JM
Krumholz
Harlan M
HM
D015906:Angioplasty, Balloon, Coronary / Q000592:standards; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards; D004636:Emergency Service, Hospital / Q000458:organization & administration; D006761:Hospitals; D006801:Humans; D016014:Linear Models; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000628:therapy*; D013997:Time Factors