This Article Full Text Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Parikh, S. V. Articles by Holper, E. M. Search for Related Content PubMed PubMed Citation Articles by Parikh, S. V. Articles by Holper, E. M. Related Collections Acute myocardial infarction Health policy and outcome research Related Article

Innovations in Care

Systems-Based Improvement in Door-to-Balloon Times at a Large Urban Teaching Hospital

A Follow-Up Study From Parkland Health and Hospital System

Shailja V. Parikh, MD; D. Brent Treichler, MD, MMM; Sheila DePaola, RN; Jennifer Sharpe, RN; Marisa Valdes, RN, BSN; Tayo Addo, MD; Sandeep R. Das, MD, MPH; Darren K. McGuire, MD, MHSc; James A. de Lemos, MD; Ellen C. Keeley, MD, MS; John J. Warner, MD and Elizabeth M. Holper, MD, MPH

From the Departments of Internal Medicine (S.V.P., T.A., S.R.D., J.J.W., E.M.H.), Division of Cardiology, and the Donald W. Reynolds Cardiovascular Clinical Research Center (D.K.G., J.A.L.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Internal Medicine (E.C.K.), Division of Cardiology, University of Virginia, Charlottesville, Va; and Departments of Emergency Medicine (D.B.T., J.S.), Cardiac Catheterization Laboratory (S.D.P.), and Performance Improvement and Patient Safety (M.V.), Parkland Health and Hospital System, Dallas, Tex.

Correspondence to Shailja V. Parikh, MD, Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, HA9133, Dallas, TX 75390. E-mail s1pari{at}parknet.pmh.org

Received September 22, 2008; accepted January 20, 2009.

Background— Timely reperfusion in ST-segment elevation myocardial infarction (STEMI) patients improves clinical outcomes. Implementing strategies to target institutional-specific delays are crucial for improved patient care.

Methods and Results— Using a novel strategy to analyze specific components of door-to-balloon time (DBT) at our institution, we previously identified several specific interval delays in our prior STEMI protocol. We then implemented 4 strategies to reduce DBT: (1) emergency department physician activation of the STEMI protocol; (2) "single call" broadcast paging of the STEMI team by the page operator; (3) immediate feedback to the emergency and cardiology departments with joint monthly quality improvement meetings; and (4) transfer of the off-hours STEMI patient directly to the laboratory on activation by an in-hospital team. After implementation of the new protocol, we examined each component time interval from the first 59 consecutive STEMI patients treated with the new protocol between March 2007 and June 2008 and compared time intervals with the previous 184 STEMI patients. Compared with the previous 184 STEMI patients, the median DBT of the subsequent 59 STEMI patients significantly improved from 125 to 86 minutes (P<0.0001). This improvement was largely driven by a decrease in the interval from the initial 12-lead ECG to activation of the on-call catheterization team (from 40 to 11 minutes, P<0.0001).

Conclusions— After examining specific component delays in our institution’s DBT, we were able to successfully use quality improvement strategies to focus on specific sources of delay in our institution. This dramatically improved our median DBT toward the goal of achieving a guideline-recommended <90 minutes for all patients.

Key Words: ST-segment elevation myocardial infarction • door-to-balloon time • quality improvement

---

 

EDITOR’S NOTE

Reprint request to Elizabeth M. Holper, MD, MPH, University of Texas Southwestern Medical Center Division of Cardiology, 5323 Harry Hines Blvd, Dallas, TX 75390-8837. E-mail elizabeth.holper@utsouthwestern.edu

Related Article

Systems-Based Improvement in Door-to-Balloon Times at a Large Urban Teaching Hospital: A Follow-Up Study From Parkland Health and Hospital System

Shailja V. Parikh, D. Brent Treichler, Sheila DePaola, Jennifer Sharpe, Marisa Valdes, Tayo Addo, Sandeep R. Das, Darren K. McGuire, James A. de Lemos, Ellen C. Keeley, John J. Warner, and Elizabeth M. Holper
Circ Cardiovasc Qual Outcomes 2009 2: 116-122. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				H. M. Krumholz Medicine in the Era of Outcomes Measurement Circ Cardiovasc Qual Outcomes, May 1, 2009; 2(3): 141 - 143. [Full Text] [PDF]