A hospital‐wide system to ensure rapid treatment time across the entire spectrum of emergency percutaneous intervention

Abstract

ObjectivesThis study's aim was to describe a hospital‐wide system to deliver rapid door‐to‐balloon time across the entire spectrum of emergency percutaneous intervention.BackgroundMany patients needing emergency PCI are excluded from door‐to‐balloon public reporting metric; these groups do not achieve door‐to‐balloon times ≤90 min and have increased mortality rates. Methods: We prospectively implemented a protocol for patients with STEMI or other emergency indication for catheterization mandating (1) emergency department physician or cardiologist activation of the catheterization lab and (2) immediate patient transfer to an immediately available catheterization lab by an in‐house nursing transfer team.ResultsFrom September 1, 2005 to December 31, 2008, 526 consecutive patients underwent emergency PCI. Median door‐to‐balloon time was 68 min with 85.7% ≤90 min overall. Important subgroups included primary emergency department (62.5 min), cardiorespiratory arrest (71 min), cardiogenic shock (68 min), need for temporary pacemaker or balloon pump (67 min), initial ECG without ST‐elevation (66.5 min), transfer from another ED (84 min), in‐hospital (70 min), and activation indications other than STEMI (68 min). Patients presenting to primary ED and in transfer were compared to historical controls. Treatment ≤90 min increased (28%–85%, P < 0.0001). Mean infarct size decreased, as did hospital length‐of‐stay and admission total hospital costs. Acute myocardial infarction all‐cause 30‐day unadjusted mortality and risk‐standardized mortality ratios were substantially lower than national averages.ConclusionA hospital‐wide systems approach applied across the entire spectrum of emergency PCI leads to rapid door‐to‐balloon time, reduced infarct size and hospitals costs, and low myocardial infarction 30‐day all‐cause mortality. © 2015 Wiley Periodicals, Inc.

Strategies to Reduce the Door-to-Device time in ST-Elevation Myocardial Infarction Patients

“…20 - 22 For example, a large number of studies have excluded patients with very long D2D times (eg, >3 h) 5 , 8 , 14 - 16 and some studies have excluded high-risk patients such as those with cardiogenic shock, cardiac arrest, and diagnostic challenges. 14 , 18 Khot et al 21 suggested that all patients undergoing PPCI be included for a real estimation of the D2D time and no exclusion be applied based on the length of delay and the medical condition of the patients, which is exactly what we did in the current study.…”

Come one, come all…the sooner the better!

“…In this issue of CCI , Khot et al describe the impact of a hospital‐wide system to deliver rapid D2B time across the entire spectrum of emergency PCI . They prospectively enrolled a consecutive series of patients from September 2005 through December 2008 with emergency catheterization lab activation irrespective of clinical indication, manner or timing of presentation, activating physician, or location within the hospital.…”