title: The effect of failure mode and effect analysis on reducing percutaneous coronary intervention hospital door-to-balloon time and mortality in ST segment elevation myocardial infarction.
abstract: BACKGROUND
  Door-to-balloon (D2B) time is an important factor in the outcome of ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention. We aimed to use failure mode and effect analysis to reduce the D2B time for patients with STEMI and to improve clinical outcomes.
  
  
  METHODS
  There were three stages in this study. In Stage 0, data collected from 2005-2006 was used to identify failures in the process, and during Stage 2 (2007) and Stage 3 (2008) the efficacy of intrahospital and interhospital strategies to reduce the D2B time were evaluated. This study enrolled 385 patients; 86 from 2005-2006; 80 in 2007; and 219 in 2008.
  
  
  RESULTS
  By making improvements in these steps, the median D2B time was reduced from 146 min to 32 min for all patients. The proportion of patients with a D2B time of <90 min significantly increased from Stage 0 to Stage 1 and from Stage 1 to Stage 2, for all patients as well as for the non-transferred and transferred subgroups of patients (all p values <0.0001). For non-transferred patients, only reinfarction-free survival showed significant difference among the three stages (p=0.0225), and for transferred patients, only overall survival showed significant difference among the three stages (p=0.0322). Cox's proportional hazards regression analysis showed Stage 2 was associated with a lower risk of reinfarction and mortality compared with Stage 0.
  
  
  CONCLUSIONS
  This study found that failure mode and effect analysis is a powerful method for identifying weaknesses in D2B processes and evaluating strategies to reduce the D2B time.
authors: Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China. fengyoukuo@gmail.com
authors: Feng-Yu
authors: FY
authors: Kuo
authors: Wei-Chun
authors: WC
authors: Huang
authors: Kuan-Rau
authors: KR
authors: Chiou
authors: Guang-Yuan
authors: GY
authors: Mar
authors: Chin-Chang
authors: CC
authors: Cheng
authors: Chen-Chi
authors: CC
authors: Chung
authors: Han-Lin
authors: HL
authors: Tsai
authors: Chen-Hung
authors: CH
authors: Jiang
authors: Shue-Ren
authors: SR
authors: Wann
authors: Shoa-Lin
authors: SL
authors: Lin
authors: Chun-Peng
authors: CP
authors: Liu
mesh_terms: D000368:Aged; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer / Q000592:standards / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention; D013624:Taiwan; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
keywords: Checklists; Clinical Practice Guidelines; Failure Modes and Effects Analysis (FMEA)