title: Implementation of multiple strategies for improved door-to-balloon time in patients with ST-segment elevation myocardial infarction.
abstract: Several strategies have been found to be associated with a significant reduction in door-to-balloon (D2B) time in the management of ST-segment elevation myocardial infarction (STEMI). The objective of this retrospective cohort study was to assess D2B time before and after specific hospital strategies, including a computerized provider order entry (CPOE), were implemented to reduce D2B time. Patients who presented to the emergency department within 12 h of STEMI were enrolled. Strategies adopted included: (1) electrocardiography during triage for patients with chest pain; (2) implementing a CPOE; (3) activating the catheterization laboratory by sending a cell phone notification via the computer system; (4) using an open real-time on-line STEMI registry; and (5) conducting a monthly meeting to review registration. A total of 134 patients were included in the study (preintervention, n = 69; postintervention, n = 65). Median D2B time improved from 83 to 63 min after the new strategies were implemented (P = 0.001). Median door-to-electrocardiogram (5-2 min) and door-to-laboratory time (60-41 min) also significantly improved (P < 0.001). The proportion of patients with a D2B time within 90 min increased from 59.4 % to 98.5 % (P < 0.001). In conclusion, our findings suggest that implementing specific strategies can substantially improve D2B time for patients with STEMI and increase the proportion of patients with D2B time less than 90 min.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 5 Fushing Street, Gueishan Shiang, Taoyuan, Taiwan.
authors.forename: Ming-Wei
authors.initials: MW
authors.lastname: Pan
authors.forename: Shou-Yen
authors.initials: SY
authors.lastname: Chen
authors.forename: Chun-Chi
authors.initials: CC
authors.lastname: Chen
authors.forename: Wei-Jan
authors.initials: WJ
authors.lastname: Chen
authors.forename: Chi-Jen
authors.initials: CJ
authors.lastname: Chang
authors.forename: Chia-Pin
authors.initials: CP
authors.lastname: Lin
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Weng
authors.forename: Yu-Cheng
authors.initials: YC
authors.lastname: Chen
mesh_terms: D000368:Aged; D019091:Critical Pathways; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014218:Triage