title: Shortening of median door-to-balloon time in primary percutaneous coronary intervention in Singapore by simple and inexpensive operational measures: clinical practice improvement program.
abstract: BACKGROUND
  Primary percutaneous coronary intervention is the standard reperfusion strategy for ST-segment elevation myocardial infarction in our center. We aimed to shorten the median door-to-balloon time from over 100 minutes to 90 minutes or less.
  
  
  METHODS
  We have been using three strategies since March 2007 to shorten the door-to-balloon time: (1) the intervention team is now activated by emergency department physicians (where previously it had been activated by coronary care unit); (2) all members of the intervention team have converted from using pagers to using cell phones; and (3) as soon as the intervention team is activated, patients are transferred immediately to the cardiac catheterization laboratory (where previously they had waited in the emergency department for the intervention team to arrive). An in-house physician and a nurse would stay with the patients before arrival of the intervention team.
  
  
  RESULTS
  During 12 months, 285 nontransfer patients (analyzed, n = 270) underwent primary PCI. The shortest monthly median door-to-balloon time was 59 minutes; the longest monthly median door-to-balloon time was 111 minutes. The overall median door-to-balloon time for the entire 12 months was 72 minutes. On a per-month basis, the median door-to-balloon time was 90 minutes or less in 10 of 12 months. On a per-patient basis, the median door-to-balloon time was 90 minutes or less in 182 patients (67.4%). There was 1 case (0.4%) of inappropriate activation by the emergency department. While waiting for the intervention team to convene, 1 patient (0.4%) deteriorated and had to be resuscitated in the cardiac catheterization laboratory.
  
  
  CONCLUSIONS
  Improved health care delivery can be achieved by changing simple and inexpensive operational processes.
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. mdclchr@nus.edu.sg
authors.forename: Chi-Hang
authors.initials: CH
authors.lastname: Lee
authors.forename: Shirley B S
authors.initials: SB
authors.lastname: Ooi
authors.forename: Edgar L
authors.initials: EL
authors.lastname: Tay
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Low
authors.forename: Swee-Guan
authors.initials: SG
authors.lastname: Teo
authors.forename: Cindy
authors.initials: C
authors.lastname: Lau
authors.forename: Bee-Choo
authors.initials: BC
authors.lastname: Tai
authors.forename: Irene
authors.initials: I
authors.lastname: Lim
authors.forename: Susan
authors.initials: S
authors.lastname: Lam
authors.forename: Ing-Haan
authors.initials: IH
authors.lastname: Lim
authors.forename: Ping
authors.initials: P
authors.lastname: Chai
authors.forename: Huay-Cheem
authors.initials: HC
authors.lastname: Tan