title: Effectiveness of a myocardial infarction protocol in reducing door-to-ballon time.
abstract: BACKGROUND
  An adequate door-to-balloon time (<120 minutes) is the necessary condition for the efficacy of primary angioplasty in infarction to translate into effectiveness.
  
  
  OBJECTIVE
  To describe the effectiveness of a quality of care protocol in reducing the door-to-balloon time.
  
  
  METHODS
  Between May 2010 and August 2012, all individuals undergoing primary angioplasty in our hospital were analyzed. The door time was electronically recorded at the moment the patient took a number to be evaluated in the emergency room, which occurred prior to filling the check-in forms and to the triage. The balloon time was defined as the beginning of artery opening (introduction of the first device). The first 5 months of monitoring corresponded to the period of pre-implementation of the protocol. The protocol comprised the definition of a flowchart of actions from patient arrival at the hospital, the team's awareness raising in relation to the prioritization of time, and provision of a periodic feedback on the results and possible inadequacies.
  
  
  RESULTS
  A total of 50 individuals were assessed. They were divided into five groups of 10 sequential patients (one group pre- and four groups post-protocol). The door-to-balloon time regarding the 10 cases recorded before protocol implementation was 200 ± 77 minutes. After protocol implementation, there was a progressive reduction of the door-to-balloon time to 142±78 minutes in the first 10 patients, then to 150±50 minutes, 131±37 minutes and, finally, 116±29 minutes in the three sequential groups of 10 patients, respectively. Linear regression between sequential patients and the door-to-balloon time (r = - 0.41) showed a regression coefficient of - 1.74 minutes.
  
  
  CONCLUSIONS
  The protocol implementation proved effective in the reduction of the door-to-balloon time.
authors.affiliation: Hospital São Rafael, Salvador, BA, Brazil. lccorreia@cardiol.br
authors.forename: Luis Cláudio Lemos
authors.initials: LC
authors.lastname: Correia
authors.forename: Mariana
authors.initials: M
authors.lastname: Brito
authors.forename: Felipe
authors.initials: F
authors.lastname: Kalil
authors.forename: Michael
authors.initials: M
authors.lastname: Sabino
authors.forename: Guilherme
authors.initials: G
authors.lastname: Garcia
authors.forename: Felipe
authors.initials: F
authors.lastname: Ferreira
authors.forename: Iracy
authors.initials: I
authors.lastname: Matos
authors.forename: Peter
authors.initials: P
authors.lastname: Jacobs
authors.forename: Liliana
authors.initials: L
authors.lastname: Ronzoni
authors.forename: Márcia
authors.initials: M
authors.lastname: Noya-Rabelo
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002985:Clinical Protocols / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011787:Quality of Health Care; D012016:Reference Values; D015203:Reproducibility of Results; D012737:Sex Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome