title: Emergency department physician activation of the catheterization laboratory and immediate transfer to an immediately available catheterization laboratory reduce door-to-balloon time in ST-elevation myocardial infarction.
abstract: BACKGROUND
  Consensus guidelines and hospital quality-of-care programs recommend that ST-elevation myocardial infarction patients achieve a door-to-balloon time of < or = 90 minutes. However, there are limited prospective data on specific measures to significantly reduce door-to-balloon time.
  
  
  RESULTS
  We prospectively determined the impact on median door-to-balloon time of a protocol mandating (1) emergency department physician activation of the catheterization laboratory and (2) immediate transfer of the patient to an immediately available catheterization laboratory by an in-house transfer team consisting of an emergency department nurse, a critical care unit nurse, and a chest pain unit nurse. We collected door-to-balloon time for 60 consecutive ST-elevation myocardial infarction patients undergoing emergency percutaneous intervention within 24 hours of presentation from October 1, 2004, through August 31, 2005, and compared this group with 86 consecutive ST-elevation myocardial infarction patients from September 1, 2005, through June 26, 2006, after protocol implementation. Median door-to-balloon time decreased overall (113.5 versus 75.5 minutes; P<0.0001), during regular hours (83.5 versus 64.5 minutes; P=0.005), during off-hours (123.5 versus 77.5 minutes; P<0.0001), and with transfer from an outside affiliated emergency department (147 versus 85 minutes; P=0.0006). Treatment within 90 minutes increased from 28% to 71% (P<0.0001). Mean infarct size decreased (peak creatinine kinase, 2623+/-3329 versus 1517+/-1556 IU/L; P=0.0089), as did hospital length of stay (5+/-7 versus 3+/-2 days; P=0.0097) and total hospital costs per admission ($26,826+/-29,497 versus $18,280+/-8943; P=0.0125).
  
  
  CONCLUSIONS
  Emergency department physician activation of the catheterization laboratory and immediate transfer of the patient to an immediately available catheterization laboratory reduce door-to-balloon time, leading to a reduction in myocardial infarct size, hospital length of stay, and total hospital costs.
authors.affiliation: Indiana Heart Physicians/St. Francis Heart Center, 5330 E Stop 11 Rd, Indianapolis, IN 46237, USA. khot@cvresearch.net
authors.forename: Umesh N
authors.initials: UN
authors.lastname: Khot
authors.forename: Michele L
authors.initials: ML
authors.lastname: Johnson
authors.forename: Curtis
authors.initials: C
authors.lastname: Ramsey
authors.forename: Monica B
authors.initials: MB
authors.lastname: Khot
authors.forename: Randall
authors.initials: R
authors.lastname: Todd
authors.forename: Saeed R
authors.initials: SR
authors.lastname: Shaikh
authors.forename: William J
authors.initials: WJ
authors.lastname: Berg
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000706:statistics & numerical data; D006328:Cardiac Catheterization; D019468:Disease Management; D042241:Early Diagnosis; D004632:Emergency Medical Services / Q000458:organization & administration; D016529:Emergency Nursing; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005392:First Aid; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006747:Hospital Communication Systems / Q000458:organization & administration*; D017721:Hospital Costs; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D033183:Interdisciplinary Communication; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000451:nursing / Q000628:therapy*; D009741:Nursing Staff, Hospital; D010348:Patient Care Team; D010360:Patient Transfer / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012042:Registries; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome