According to this study:
* The "door-to-balloon" time should not exceed 90 minutes.
* Implementing specific strategies can significantly shorten that time.
Primary percutaneous coronary intervention is the preferred treatment for patients with acute myocardial infarction with ST-segment elevation. National standards recommend that the "door-to-balloon" time-the length of time between arrival at the ED and the first inflation of the angioplasty balloon-not exceed 90 minutes. However, only about 20% of U.S. hospitals meet that benchmark.
Representatives of 365 acute care hospitals in the United States responded to a survey designed to assess the use of 28 strategies instituted by hospitals that have a short door-to-balloon time. The results revealed that the median times at the surveyed facilities varied widely, with a mean of the median times of all hospitals of 100.4 +/- 23.5 minutes. Six strategies were found to be strongly associated with a shorter door-to-balloon time:
* the ED physician activates the catheterization laboratory without waiting for a cardiologist's authorization (mean reduction, 8.2 minutes)
* the ED and catheterization laboratory staff use real-time data feedback (mean reduction, 8.6 minutes)
* the ED physician places a single call to a central paging operator, who pages the cardiologist and the catheterization laboratory (mean reduction, 13.8 minutes)
* a cardiologist is on site at all times (mean reduction, 14.6 minutes)
* the ED physician activates the catheterization laboratory before the patient arrives based on electrocardiographic (ECG) data transmitted by emergency medical service personnel during transport (mean reduction, 15.4 minutes)
* staff members arrive at the catheterization laboratory within 20 (rather than 30) minutes of being paged (mean reduction, 19.3 minutes)
Although implementing some of these six strategies would require hospitals to invest in new resources, others-such as having the ED physician activate the catheterization laboratory without waiting for a cardiologist and basing activation of the laboratory on ECG data transmitted during patient transport-could be instituted without additional investment.
JC