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"Register and Roll": A Novel Initiative to Improve First Door-to-Balloon Time in ST Elevation Myocardial Infarction.

Amruthlal Jain SK, Ismail Y, Shaw M, David S, Alexander P - Cardiol Res Pract (2012)

Bottom Line: An analysis of effect was conducted from March 2009 to July 2011.After implementation, the EMS activation time has significantly decreased and time to reperfusion approaches recommended goal (Median 114 min versus 90 min, P < 0.001), with 55% in <90 minutes.This initiative is easily instituted and reliable in a community hospital setting where resources are limited.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Providence Heart Institute, 16001 West Nine Mile Road, Southfield, MI 48075, USA.

ABSTRACT
Objective. We examined the cause of transfer delay in patients with an acute ST-segment myocardial infarction (STEMI) from non percutaneous coronary intervention (PCI) capable to PCI capable hospitals. We then implemented a novel, simple, and reliable initiative to improve the transfer process. Background. Guidelines established by the ACC/AHA call for door-to-balloon times of ≤90 minutes for patients with STEMI. When hospital transfer is necessary, this is only met in 8.6% of cases. Methods. All patients presenting with STEMI to a non-PCI capable hospital from April 2006 to February 2009 were analyzed retrospectively. After identifying causes of transfer delay the "Register and Roll" initiative was developed. An analysis of effect was conducted from March 2009 to July 2011. Results. 144 patients were included, 74 pre-initiative and 70 post- initiative. Time to EMS activation was a major delay in patient transfer. After implementation, the EMS activation time has significantly decreased and time to reperfusion approaches recommended goal (Median 114 min versus 90 min, P < 0.001), with 55% in <90 minutes. Conclusion. "Register and Roll" streamlines the triage process and improves hospital transfer times. This initiative is easily instituted and reliable in a community hospital setting where resources are limited.

No MeSH data available.


Related in: MedlinePlus

Percent patients with door-to-balloon times.
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fig2: Percent patients with door-to-balloon times.

Mentions: Analysis of the key time intervals in the study group demonstrates the dramatic effect our initiative had in reducing triage times. The documented time to ECG was reduced threefold compared to the control group (5 versus 1.5 minutes, P < 0.001Table 2). Time to EMS activation was reduced significantly, resulting in reduced time to transfer times. Time to transfer was not affected by changes in EMS procedures as EMS arrived in less than 10 minutes for both groups and as expected, both groups had similar transport times. Time to Transfer included the time patient arrived to the first hospital and left the first hospital (door-in-door-out time). Changes to procedures at the non-PCI hospital also reduced clinical times in the catheterization laboratory as evidenced by a 5-minute reduction in door-to-balloon times (Table 2). The mean key time intervals are shown in graphical representation in Figure 1. Overall, our 1st D2B times were reduced by the register and roll initiative by nearly 72% overall. More significantly, implementation resulted in achieving a 1st D2B time of 90 minutes in the majority of patients (Figure 2).


"Register and Roll": A Novel Initiative to Improve First Door-to-Balloon Time in ST Elevation Myocardial Infarction.

Amruthlal Jain SK, Ismail Y, Shaw M, David S, Alexander P - Cardiol Res Pract (2012)

Percent patients with door-to-balloon times.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472551&req=5

fig2: Percent patients with door-to-balloon times.
Mentions: Analysis of the key time intervals in the study group demonstrates the dramatic effect our initiative had in reducing triage times. The documented time to ECG was reduced threefold compared to the control group (5 versus 1.5 minutes, P < 0.001Table 2). Time to EMS activation was reduced significantly, resulting in reduced time to transfer times. Time to transfer was not affected by changes in EMS procedures as EMS arrived in less than 10 minutes for both groups and as expected, both groups had similar transport times. Time to Transfer included the time patient arrived to the first hospital and left the first hospital (door-in-door-out time). Changes to procedures at the non-PCI hospital also reduced clinical times in the catheterization laboratory as evidenced by a 5-minute reduction in door-to-balloon times (Table 2). The mean key time intervals are shown in graphical representation in Figure 1. Overall, our 1st D2B times were reduced by the register and roll initiative by nearly 72% overall. More significantly, implementation resulted in achieving a 1st D2B time of 90 minutes in the majority of patients (Figure 2).

Bottom Line: An analysis of effect was conducted from March 2009 to July 2011.After implementation, the EMS activation time has significantly decreased and time to reperfusion approaches recommended goal (Median 114 min versus 90 min, P < 0.001), with 55% in <90 minutes.This initiative is easily instituted and reliable in a community hospital setting where resources are limited.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Providence Heart Institute, 16001 West Nine Mile Road, Southfield, MI 48075, USA.

ABSTRACT
Objective. We examined the cause of transfer delay in patients with an acute ST-segment myocardial infarction (STEMI) from non percutaneous coronary intervention (PCI) capable to PCI capable hospitals. We then implemented a novel, simple, and reliable initiative to improve the transfer process. Background. Guidelines established by the ACC/AHA call for door-to-balloon times of ≤90 minutes for patients with STEMI. When hospital transfer is necessary, this is only met in 8.6% of cases. Methods. All patients presenting with STEMI to a non-PCI capable hospital from April 2006 to February 2009 were analyzed retrospectively. After identifying causes of transfer delay the "Register and Roll" initiative was developed. An analysis of effect was conducted from March 2009 to July 2011. Results. 144 patients were included, 74 pre-initiative and 70 post- initiative. Time to EMS activation was a major delay in patient transfer. After implementation, the EMS activation time has significantly decreased and time to reperfusion approaches recommended goal (Median 114 min versus 90 min, P < 0.001), with 55% in <90 minutes. Conclusion. "Register and Roll" streamlines the triage process and improves hospital transfer times. This initiative is easily instituted and reliable in a community hospital setting where resources are limited.

No MeSH data available.


Related in: MedlinePlus