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Achievement of a median door-to-balloon time of less than 90 minutes by implementation of organizational changes in the 'Emergency Department to Cath Lab' pathway: a 5-year analysis.
MedLine Citation:
PMID:  21504514     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Rationale  At present, most patients presenting directly to emergency departments (EDs) do not meet the recommended door-to-balloon goal of less than 90 minutes for ST-elevation myocardial infarction (STEMI) patients. Until the year 2005, the goal of less than 90 minutes door-to-balloon time has been rarely achieved in our hospital (i.e. 17% of all cases). Method  Some organizational changes - including immediate involvement of the cardiologist in ED - were established to improve our performance. To evaluate the results of these changes, we have measured the intervals pain-to-door, door-to-electrocardiogram (ECG) and ECG-to-balloon for all the consecutive STEMI patients (n = 206) observed in our hospital during three sample months (May to July) of the years 2005 to 2009. We have then calculated the times door-to-balloon and pain-to-balloon (total ischemic time). Results  We have demonstrated that the door-to-balloon time has been progressively reduced to less than 90 minutes in 73% of patients. Only 4.5% of all patients still have a door-to-balloon time greater than 150 minutes (17% in 2005). It is also notable the 60% reduction (from 330 to 140 minutes) of the pain-to-door time, the so-called 'out of hospital avoidable delay', was achieved by a sensitization campaign directed to the whole population of the province. Conclusion  Taken together, all these organizational changes have allowed to reduce the total ischemic time from 465 minutes in year 2005 to 232 minutes in year 2009, thereby demonstrating the effectiveness of our intervention.
Authors:
Ivan Comelli; Luigi Vignali; Angelo Rolli; Giuseppe Lippi; Gianfranco Cervellin
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-19
Journal Detail:
Title:  Journal of evaluation in clinical practice     Volume:  -     ISSN:  1365-2753     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9609066     Medline TA:  J Eval Clin Pract     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 Blackwell Publishing Ltd.
Affiliation:
Assistant, Director, Emergency Department, University Hospital of Parma, Parma, Italy Senior Assistant, Cardiology, University Hospital of Parma, Parma, Italy Director, Laboratory Medicine, University Hospital of Parma, Parma, Italy.
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