title: Improving door-to-balloon time by decreasing door-to-ECG time for walk-in STEMI patients.
abstract: BACKGROUND
  The American Heart Association/American College of Cardiology guidelines recommend rapid door-to-electrocardiography (ECG) times for patients with ST-segment elevation myocardial infarction (STEMI). Previous quality improvement research at our institution revealed that we were not meeting this benchmark for walk-in STEMI patients. The objective is to investigate whether simple, directed changes in the emergency department (ED) triage process for potential cardiac patients could decrease door-to-ECG times and secondarily door-to-balloon times.
  
  
  METHODS
  We conducted an interventional study at a large, urban, public teaching hospital from April 2010 to June 2012. All patients who walked into the ED with a confirmed STEMI were enrolled in the study. The primary intervention involved creating a chief complaint-based "cardiac triage" designation that streamlined the evaluation of potential cardiac patients. A secondary intervention involved moving our ECG technician and ECG station to our initial triage area. The primary outcome measure was door-to-ECG time and the secondary outcome measure was door-to-balloon time.
  
  
  RESULTS
  We enrolled 91 walk-in STEMI patients prior to the intervention period and 141 patients after the invention. We observed statistically significant reductions in door-to-ECG time (43±93 to 30±72 minutes, median 23 to 14 minutes p<0.01), ECG-to-activation time (87±134 to 52±82 minutes, median 43 to 31 minutes p<0.01), and door-to-balloon time (134±146 to 84±40 minutes, median 85 -75 minutes p=0.03).
  
  
  CONCLUSIONS
  By creating a chief complaint-based cardiac triage protocol and by streamlining ECG completion, walk-in STEMI patients are systematically processed through the ED. This is not only associated with a decrease in door-to-balloon time, but also a decrease in the variability of the time sensitive intervals of door-to-ECG and ECG-to-balloon time.
authors: Los Angeles County/University of Southern California, Department of Emergency Medicine, Los Angeles, California.
authors: Christopher J
authors: CJ
authors: Coyne
authors: Los Angeles County/University of Southern California, Department of Emergency Medicine, Los Angeles, California.
authors: Nicholas
authors: N
authors: Testa
authors: Los Angeles County/University of Southern California, Department of Emergency Medicine, Los Angeles, California.
authors: Shoma
authors: S
authors: Desai
authors: Los Angeles County/University of Southern California, Los Angeles, California.
authors: Joy
authors: J
authors: Lagrone
authors: Los Angeles County/University of Southern California, Los Angeles, California.
authors: Roger
authors: R
authors: Chang
authors: Los Angeles County/University of Southern California, Los Angeles, California.
authors: Ling
authors: L
authors: Zheng
authors: Los Angeles County/University of Southern California, Department of Emergency Medicine, Los Angeles, California.
authors: Hyung
authors: H
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D013997:Time Factors; D014218:Triage / Q000379:methods* / Q000706:statistics & numerical data