Document Detail

Door-to-balloon times are reduced in ST-elevation myocardial infarction by emergency physician activation of the cardiac catheterisation laboratory and immediate patient transfer.
MedLine Citation:
PMID:  20712540     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To assess whether a collaborative interdepartmental pathway involving emergency department (ED) physicians activating the cardiac catheterisation laboratory (CCL) with immediate patient transfer to the CCL reduces door-to-balloon (DTB) times for patients with suspected ST-elevation myocardial infarction (STEMI). DESIGN, SETTING AND PARTICIPANTS: A quasi-experimental before-and-after observational study using a prospective database, supplemented by chart review, of consecutive patients transferred from the ED to the CCL for suspected STEMI, from January 2007 to October 2009, at Sir Charles Gairdner Hospital, an adult tertiary-care hospital, Western Australia. MAIN OUTCOMES MEASURES: Median DTB time and proportion of patients with DTB time of < 90 minutes. Secondary outcomes, based on analysis of predefined subgroups, included door-to-activation time, activation-to-balloon time and false-positive activations of the CCL. RESULTS: Two hundred and thirty-four patients underwent emergency coronary angiography for suspected STEMI, with 188 (80%) undergoing percutaneous coronary intervention (118 before and 70 after implementation of the new pathway). Following implementation of the new pathway, median DTB time reduced from 97 to 77 minutes (P < 0.001), median door-to-activation time from 28 to 15 minutes (P = 0.002) and median activation-to-balloon time from 66 to 53 minutes (P < 0.001). The proportion of patients with recommended DTB time of < 90 minutes increased from 41% to 77% (P < 0.001) with no change in false positive CCL activation rates (12% v 11%; P = 0.38). CONCLUSION: ED physician activation of CCL with immediate patient transfer is associated with highly significant improvements in DTB time without increased false positive rates.
Alexander B Willson; David Mountain; Joanne M Jeffers; Cheryl G Blanton; Brendan M McQuillan; Joseph Hung; Michael H Muhlmann; Michael C Nguyen
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Medical journal of Australia     Volume:  193     ISSN:  0025-729X     ISO Abbreviation:  Med. J. Aust.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-17     Completed Date:  2010-09-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0400714     Medline TA:  Med J Aust     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  207-12     Citation Subset:  IM    
Cardiovascular Medicine Department, Sir Charles Gairdner Hospital, Perth, WA, Australia.
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MeSH Terms
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary*
Cardiology Service, Hospital*
Critical Pathways*
Electrocardiogram Pattern
Emergency Service, Hospital*
Middle Aged
Myocardial Infarction / therapy*
Patient Transfer
Retrospective Studies
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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