Sustaining Improvement in Door-to-Balloon Time Over 4 Years

Nestler, David M.; Noheria, Amit; Haro, Luis H.; Ganti, Latha; Decker, Wyatt W.; Scanlan-Hanson, Lori N.; Lennon, Ryan J.; Lim, Choon Chern; Holmes, David R.; Rihal, Charanjit S.; Bell, Malcolm R.; Ting, Henry H.

doi:10.1161/circoutcomes.108.839225

Cited by 41 publications

(15 citation statements)

References 16 publications

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“…21 The Mayo PH ECG protocol extended these findings and integrated 4 key features, including (1) PH ECG acquisition; (2) EMS interpretation without PH ECG transmission; (3) prehospital activation of the cardiac catheterization team; and (4) ED bypass which resulted in a median DTB and FMCTB times of 32 minutes and 58 minutes, respectively. No other significant changes occurred with treatment of STEMI patients, either in the prehospital setting or in the ED, during this study period.…”

Section: Discussionmentioning

confidence: 96%

“…A single-call paging system has been recommended by the D2B Alliance as a key strategy for hospitals to reduce DTB. 25 We had already been using a single-call system for ED STEMI activations, 21 and we simply enabled paramedics to call the same telephone number for prehospital activations. Finally, once the paramedics had activated the cardiac catheterization laboratory, the patient bypassed the ED entirely and went directly to the laboratory.…”

Section: Discussionmentioning

confidence: 99%

“…The ECC coordinates and dispatches ground and air ambulances for 30 regional hospitals in Minnesota, Wisconsin, and Iowa. 21 The catheterization team was expected to arrive at the hospital and begin the procedure within 20 to 30 minutes of activation. The patient would bypass the ED and was transported directly to the cardiac catheterization laboratory.…”

Section: Interventionmentioning

confidence: 99%

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Impact of Prehospital Electrocardiogram Protocol and Immediate Catheterization Team Activation for Patients With ST-Elevation–Myocardial Infarction

Nestler

White

Rihal

et al. 2011

Circ: Cardiovascular Quality and Outcomes

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

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Impact of Prehospital Electrocardiogram Protocol and Immediate Catheterization Team Activation for Patients With ST-Elevation–Myocardial Infarction

Nestler

White

Rihal

et al. 2011

Circ: Cardiovascular Quality and Outcomes

Self Cite

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“…The authors' experience demonstrates the effectiveness and durability of process changes targeting timeliness of primary percutaneous coronary intervention. 2 Heart Institute at Abbott Northwestern Hospital (Minneapolis, MN) are tracked by 3 distinct quality assurance programs: NCDR, TJC, and the level 1 MI registry (a regional system for percutaneous coronary intervention in STEMI that includes transfer patients). Over 1 year, the authors examined consecutive STEMI patients in level 1 and compared them with individuals meeting NCDR and TJC inclusion criteria.…”

Section: Discussionmentioning

confidence: 99%

Circulation: Cardiovascular Quality and Outcomes Editors' Picks

2012

Circ: Cardiovascular Quality and Outcomes

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The following are highlights from the new series, Circulation: Cardiovascular Quality and Outcomes Topic Review. This series will summarize the most important manuscripts, as selected by the editors, that have published in the Circulation portfolio. The objective of this new series is to provide our readership with a timely, comprehensive selection of important papers that are relevant to the quality and outcomes and general cardiology audience. The studies included in this article represent the most significant research in the area of ST-segment elevation myocardial infarction care and address improvements in the timeliness of care, strategies for initial treatment-particularly with respect to reperfusion therapies-and trends. (Circ Cardiovasc Qual Outcomes. 2012;5:e1-e8.) Temporal Conclusions: The rapid changes in practice patterns demonstrated in this analysis suggest that a collaborative partnership between the public media, professional societies, and academic organizations is needed to accurately distill and disseminate pivotal scientific information that has the potential to rapidly influence both physicians and patients. 1 Sustaining Improvement in Door-to-Balloon Time Over 4 Years: The Mayo Clinic ST-Elevation Myocardial Infarction ProtocolSummary: American College of Cardiology/American Heart Association guidelines recommend a door-to-balloon time (DTB) Ͻ90 minutes for nontransferred patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention. Systems of care to achieve and sustain this DTB performance over several years have not been previously reported. The Mayo Clinic STEMI protocol was implemented in April 2004 and included activation of the cardiac catheterization laboratory by the emergency medicine physician; a single call system to activate the catheterization laboratory; catheterization laboratory staff arrival within 20 -30 minutes of activation; and real-time performance feedback within 24 -48 hours. Data were collected on nontransferred STEMI patients. Conclusions:The Mayo Clinic STEMI protocol implemented strategies to reduce DTB for nontransferred patients with STEMI. DTB was significantly reduced, and the results were sustained over the 4-year follow-up period. The authors' experience demonstrates the effectiveness and durability of process changes targeting timeliness of primary percutaneous coronary intervention. 2 ST-Elevation Myocardial Infarction: Which Patients Do Quality Assurance Programs Include?Summary: In the United States, efforts are underway to improve timely access to percutaneous coronary intervention in ST-elevation myocardial infarction (STEMI). The Joint Commission (TJC) and the American College of Cardiology National Cardiovascular Data Registry (NCDR) have developed standardized definitions and clinical performance measures for STEMI. The purpose of this study was to determine differences in 3 quality assurance registries for STEMI patients. STEMI patients presenting to the Minneapolis Correspondence to The Edito...

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“…1,2 Many hospital systems have achieved the targeted door-to-balloon time Ͻ90 minutes for 75% of patients with STEMI presenting directly to a hospital with percutaneous coronary intervention capability. 3 However, prehospital delay from time of symptom onset to hospital arrival remains the largest portion of the total delay time and has been refractory to interventions aimed at improving patient responsiveness.…”

mentioning

confidence: 99%