Summary

Background:

Outcomes of patients with acute ST-elevation myocardial infarction (STEMI) are strongly correlated to the time interval from hospital entry to primary percutaneous coronary intervention (PPCI). Current guidelines recommend a door to balloon time of < 90 minutes. 

Objectives:

To reduce the time from hospital admission to PPCI and to increase the proportion of patients treated within 90 minutes. 

Methods:

In March 2013 the authors launched a seven-component intervention program: 

1. Direct patient evacuation by out-of-hospital emergency medical services to the coronary intensive care unit or catheterization laboratory
2. Education program for the emergency department staff
3. Dissemination of information regarding the urgency of the PPCI decision
4. Activation of the catheterization team by a single phone call
5. Reimbursement for transportation costs to on-call staff who use their own cars
6. Improvement in the quality of medical records
7. Investigation of failed cases and feedback 

Results:

During the 14 months prior to the intervention, initiation of catheterization occurred within 90 minutes of hospital arrival in 88/133 patients(65%); during the 18 months following the start of the intervention, the rate was 181/200 (90%) (P < 0.01). The respective mean/median times to treatment were 126/67 minutes and 52/47 minutes (P < 0.01). Intervention also resulted in shortening of the time interval from hospital entry to PPCI on nights and weekends. 

Conclusions:

Following implementation of a comprehensive intervention, the time from hospital admission to PPCI of STEMI patients shortened significantly, as did the proportion of patients treated within 90 minutes of hospital arrival.