title: A hospital-wide system to ensure rapid treatment time across the entire spectrum of emergency percutaneous intervention.
abstract: OBJECTIVE
  This study's aim was to describe a hospital-wide system to deliver rapid door-to-balloon time across the entire spectrum of emergency percutaneous intervention.
  
  
  BACKGROUND
  Many patients needing emergency PCI are excluded from door-to-balloon public reporting metric; these groups do not achieve door-to-balloon times ≤90 min and have increased mortality rates.
  
  
  METHODS
  We prospectively implemented a protocol for patients with STEMI or other emergency indication for catheterization mandating (1) emergency department physician or cardiologist activation of the catheterization lab and (2) immediate patient transfer to an immediately available catheterization lab by an in-house nursing transfer team.
  
  
  RESULTS
  From September 1, 2005 to December 31, 2008, 526 consecutive patients underwent emergency PCI. Median door-to-balloon time was 68 min with 85.7% ≤90 min overall. Important subgroups included primary emergency department (62.5 min), cardiorespiratory arrest (71 min), cardiogenic shock (68 min), need for temporary pacemaker or balloon pump (67 min), initial ECG without ST-elevation (66.5 min), transfer from another ED (84 min), in-hospital (70 min), and activation indications other than STEMI (68 min). Patients presenting to primary ED and in transfer were compared to historical controls. Treatment ≤90 min increased (28%-85%, P < 0.0001). Mean infarct size decreased, as did hospital length-of-stay and admission total hospital costs. Acute myocardial infarction all-cause 30-day unadjusted mortality and risk-standardized mortality ratios were substantially lower than national averages.
  
  
  CONCLUSIONS
  A hospital-wide systems approach applied across the entire spectrum of emergency PCI leads to rapid door-to-balloon time, reduced infarct size and hospitals costs, and low myocardial infarction 30-day all-cause mortality. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Cleveland Clinic Department of Cardiovascular Medicine, Cleveland, Ohio.
authors.forename: Umesh N
authors.initials: UN
authors.lastname: Khot
authors.affiliation: Society of Cardiovascular Patient Care, Columbus, Ohio.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Johnson-Wood
authors.affiliation: Franciscan St. Francis Health Indianapolis, Indianapolis, Indiana.
authors.forename: Robert
authors.initials: R
authors.lastname: VanLeeuwen
authors.affiliation: Curtis Ramsey & Associates, Indianapolis, Indiana.
authors.forename: Curtis
authors.initials: C
authors.lastname: Ramsey
authors.affiliation: Cleveland Clinic Department of Cardiovascular Medicine, Cleveland, Ohio.
authors.forename: Monica B
authors.initials: MB
authors.lastname: Khot
mesh_terms: D004562:Electrocardiography; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors
keywords: angioplasty and stenting; healthcare costs; percutaneous coronary intervention; public reporting; quality improvement; stents