title: Comprehensive hospital care improvement strategies reduce time to treatment in ST-elevation acute myocardial infarction.
abstract: BACKGROUND
  Delay in treatment of patients with ST-elevation acute myocardial infarction (STEMI) has an adverse effect on patient outcomes. Limited data are available on the effectiveness of hospital care improvement strategies (HCIS) to reduce time to reperfusion by percutaneous coronary intervention (PCI). This study evaluated the combined effect of HCIS implementation to reduce door-to-balloon time in patients with STEMI.
  
  
  METHODS
  Retrospective chart review was done for 95 consecutive patients with STEMI who underwent PCI at Charleston Area Medical Center. Patients with non-STEMI and patients transferred from other medical centers were excluded. Door-to-balloon time was defined as time from emergency department arrival to first PCI balloon inflation. A program of 3 HCIS was implemented: 1) a fast-track catheterization laboratory protocol, 2) feedback to cardiologists on their treatment times, and 3) a weekday 24-hour inhouse catheterization laboratory team. Patients were separated into groups before (n = 46), during (n = 18), and after (n = 31) HCIS implementation.
  
  
  RESULTS
  Mean age was 60.3 +/- 13 years and 74% were male. The majority (64%) arrived by ambulance; 29% had a prehospital electrocardiogram done. Most patients presented during the day (68%) on weekdays (75%). Symptom onset-to-door time was 289 +/- 393 minutes. No significant differences were found between the groups for these variables. Door-to-PCI time in minutes was reduced in the group after versus the group before HCIS implementation (94.3 +/- 37 vs 133.5 +/- 53; P < 0.0001).
  
  
  CONCLUSIONS
  Implementation of HCIS shortened door-to-PCI time for patients with STEMI by 39.2 +/- 10 minutes. Thus, HCIS may be effective in improving patient outcomes.
authors.affiliation: Charleston Area Medical Center, Charleston, West Virginia, USA. jonathan@acutecardiology.com
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Lipton
authors.forename: Mike
authors.initials: M
authors.lastname: Broce
authors.forename: Dan
authors.initials: D
authors.lastname: Lucas
authors.forename: Kathleen
authors.initials: K
authors.lastname: Mimnagh
authors.forename: Anne
authors.initials: A
authors.lastname: Matthews
authors.forename: Bernardo
authors.initials: B
authors.lastname: Reyes
authors.forename: John
authors.initials: J
authors.lastname: Burdette
authors.forename: Galen S
authors.initials: GS
authors.lastname: Wagner
authors.forename: Stafford G
authors.initials: SG
authors.lastname: Warren