Achieving sustainable first door-to-balloon times of 90 minutes for regional transfer ST-segment elevation myocardial infarction.
OBJECTIVE
A network approach to transfer ST-segment elevation myocardial infarction (STEMI) patients can achieve durable first door-to-balloon times (1st D2B) for percutaneous coronary intervention (PCI) within 90 min.


BACKGROUND
Nationally, a minority of STEMI patients from referral centers obtain 1st D2B in <2 h and even fewer in <90 min.


METHODS
Included were transfer STEMI patients from 9 network hospitals treated in 2007 compared with 2008 to 2011 after installing the following initiatives: 1) established hospital referral system; 2) goal-oriented performance protocols; 3) expedited transport by ground or air; 4) first hospital activation of the PCI hospital catheterization laboratory; and 5) outreach coordinator and patient-level web-based feedback to the referring hospital.


RESULTS
A total of 101 STEMI patients transported in 2007 were compared with 442 STEMI patients transferred after starting these initiatives for STEMI from 2008 to 2011, with the median door-in to door-out time decreased from 44 to 35 min (p < 0.0001), the median 1st D2B decreasing from 109.5 to 88.0 min (p < 0.0001), and the percentage under 90 min increased from 22.8% to 55.9% (p < 0.0001). Overall, throughout the study period (2007 to 2011), the transport times remained consistent (median 36.5 vs. 36.0 min, p = 0.98), whereas the PCI hospital D2B decreased from 20.0 to 16.0 min (p < 0.0001). Length of stay and in-hospital mortality remained low at 3.0 days and under 4%, respectively.


CONCLUSIONS
A system-wide network program can achieve sustained (over 4 years) 1st D2B times of <90 min.
Sanger Heart & Vascular Institute, Carolinas Medical Center, Charlotte, North Carolina. Electronic address: hadley.wilson@carolinashealthcare.org.
B Hadley
BH
Wilson
Angela D
AD
Humphrey
John C
JC
Cedarholm
William E
WE
Downey
Robert H
RH
Haber
Glen J
GJ
Kowalchuk
Michael J
MJ
Rinaldi
Denise A
DA
Miller
Jennifer L
JL
Sarafin
J Lee
JL
Garvey
D019983:Guideline Adherence; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009657:North Carolina; D010360:Patient Transfer / Q000592:standards; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D012017:Referral and Consultation; D012040:Regional Health Planning; D013022:South Carolina; D013997:Time Factors; D061665:Time-to-Treatment / Q000592:standards; D016896:Treatment Outcome
1st D2B; ACTION; Acute Coronary Treatment and Intervention Outcome Network; DIDO; PCI; ST-segment elevation; ST-segment elevation myocardial infarction; STEMI; door-in to door-out; first door-to-balloon; infarction; percutaneous coronary intervention; systems of care; transfer