title: Systems-based improvement in door-to-balloon times at a large urban teaching hospital: a follow-up study from Parkland Health and Hospital System.
abstract: BACKGROUND
  Timely reperfusion in ST-segment elevation myocardial infarction (STEMI) patients improves clinical outcomes. Implementing strategies to target institutional-specific delays are crucial for improved patient care.
  
  
  RESULTS
  Using a novel strategy to analyze specific components of door-to-balloon time (DBT) at our institution, we previously identified several specific interval delays in our prior STEMI protocol. We then implemented 4 strategies to reduce DBT: (1) emergency department physician activation of the STEMI protocol; (2) "single call" broadcast paging of the STEMI team by the page operator; (3) immediate feedback to the emergency and cardiology departments with joint monthly quality improvement meetings; and (4) transfer of the off-hours STEMI patient directly to the laboratory on activation by an in-hospital team. After implementation of the new protocol, we examined each component time interval from the first 59 consecutive STEMI patients treated with the new protocol between March 2007 and June 2008 and compared time intervals with the previous 184 STEMI patients. Compared with the previous 184 STEMI patients, the median DBT of the subsequent 59 STEMI patients significantly improved from 125 to 86 minutes (P<0.0001). This improvement was largely driven by a decrease in the interval from the initial 12-lead ECG to activation of the on-call catheterization team (from 40 to 11 minutes, P<0.0001).
  
  
  CONCLUSIONS
  After examining specific component delays in our institution's DBT, we were able to successfully use quality improvement strategies to focus on specific sources of delay in our institution. This dramatically improved our median DBT toward the goal of achieving a guideline-recommended <90 minutes for all patients.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex, USA.
authors.forename: Shailja V
authors.initials: SV
authors.lastname: Parikh
authors.forename: D Brent
authors.initials: DB
authors.lastname: Treichler
authors.forename: Sheila
authors.initials: S
authors.lastname: DePaola
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sharpe
authors.forename: Marisa
authors.initials: M
authors.lastname: Valdes
authors.forename: Tayo
authors.initials: T
authors.lastname: Addo
authors.forename: Sandeep R
authors.initials: SR
authors.lastname: Das
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Keeley
authors.forename: John J
authors.initials: JJ
authors.lastname: Warner
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Holper
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000592:standards* / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006784:Hospitals, Teaching / Q000592:standards / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D013781:Texas; D013997:Time Factors; D014187:Transportation of Patients / Q000592:standards* / Q000706:statistics & numerical data