title: Call-to-balloon time dashboard in patients with ST-segment elevation myocardial infarction results in significant improvement in the logistic chain.
abstract: OBJECTIVE
  Timely reperfusion with primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients is associated with superior clinical outcomes. Aiming to reduce ischaemic time, an innovative system for home-to-hospital (H2H) time monitoring was implemented, which enabled real-time evaluation of ischaemic time intervals, regular feedback and improvements in the logistic chain. The objective of this study was to assess the results after implementation of the H2H dashboard for monitoring and evaluation of ischaemic time in STEMI patients.
  
  
  RESULTS
  Ischaemic time in STEMI patients transported by emergency medical services (EMS) and treated with pPCI in the Noordwest Ziekenhuis, Alkmaar before (2008-2009; n=495) and after the implementation of the H2H dashboard (2011-2014; n=441) was compared. Median time intervals were significantly shorter in the H2H group (door-to-balloon time 32 [IQR 25-43] vs. 40 [IQR 28-55] minutes, p-value <0.001, FMC-to-balloon time 62 [IQR 52-75] vs. 80 [IQR 67-103] minutes, p-value <0.001, and treatment delay 142 [IQR 103-221] vs. 159 [IQR 123-253] minutes, p-value <0.001). The H2H time dashboard was independently associated with shorter time delays.
  
  
  CONCLUSIONS
  Real-time monitoring and feedback on time delay with the H2H dashboard improves the logistic chain in STEMI patients, resulting in shorter ischaemic time intervals.
authors.affiliation: Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Maaike P J
authors.initials: MPJ
authors.lastname: Hermans
authors.forename: Matthijs A
authors.initials: MA
authors.lastname: Velders
authors.forename: Martin
authors.initials: M
authors.lastname: Smeekes
authors.forename: Olivier S
authors.initials: OS
authors.lastname: Drexhage
authors.forename: Raymond W M
authors.initials: RWM
authors.lastname: Hautvast
authors.forename: Timon
authors.initials: T
authors.lastname: Ytsma
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Victor A W M
authors.initials: VAWM
authors.lastname: Umans
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome