Improvement in door‐to‐balloon times in management of acute ST‐segment elevation myocardial infarction STEMI through the initiation of ‘Code AMI’

Abstract

We have shown that ongoing review through a quality improvement programme improves door-to-balloon times, which is integral in the optimal management of patients with acute STEMI treated with primary PCI.

Workflow Optimization in Vertebrobasilar Occlusion

“…The observation of shorter intrahospital time periods after implementation of a quality management programme is congruent to the findings of Ahmar et al [14]. They showed an improved door-to-balloon time until percutaneous intervention in acute myocardial infarction after the establishment of a quality-improvement programme involving the cardiology and emergency departments.…”

“…Their results demonstrate the feasibility of implementing strategies to optimize the timeliness of coronary reperfusion therapy. Ahmar et al established an acute ST-increase myocardial infarction-management protocol and evaluated the effectiveness for improving the door-to-balloon time for PCI [14]. They observed improved door-to-balloon times after the implementation of ongoing review through a quality-improvement programme in patients with acute myocardial infarction.…”

A systematic review of factors predicting door to balloon time in ST-segment elevation myocardial infarction treated with percutaneous intervention

“…Effect on door to balloon time: Increase = ↑, Decrease = ↓. [5,17,20,28,30,32,33,40,43,48,49,55,62,69,72,73,86] over no effect [38,98] Moderate…”

“…Care processes associated with shorter door to balloon times are presented in Table 4 and include: ER physician activates cath lab (including several variations) [80,[82][83][84]88,93,95,100], single call to a central page to activate cath lab [78,100], requiring that staff arrive within 20 min of page [100], ER activating cath lab while patient is en route [100], ER and cath lab receiving real time feedback [100], attending cardiologist always on site [100], passive monitoring of physician performance [92], obtaining a pre-hospital ECG (including several variations) [15,16,23,25,29,35,37,57,63,64,77,97], initial culprit vessel PCI before full diagnostic angiography [19,46] and initiation of a quality improvement initiative or critical pathway [17,79,87,[89][90][91]94,96,99]. Longer times are reported with improperly low initial triage of emergency patients with STEMI [66] and use of an intraaortic balloon pump [5].…”

“…than a cardiologist initially after the diagnosis of STEMI [85]. "Other" characteristics associated with longer door to balloon time include earlier year of PCI [18,34,41,[50][51][52]69,71] and "off hours" presentation [5,17,20,28,30,32,33,38,40,43,48,49,55,62,69,72,73,86,98]. While weekend or off-hours presentation was associated with longer door to balloon time in almost all reports, several authors reported that quality improvement protocols or initiatives can diminish or erase these differences [17,72].…”