Coyne, C. J., Testa, N., Desai, S., Lagrone, J., Chang, R., Zheng, L., & Kim, H. (2015). Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients. Western Journal of Emergency Medicine, 16(1), 184-9. Web.
The guidelines provided by the American College of Cardiology/American Heart Association recommend fast door-to-electrocardiography (ECG) times for STEMI patients. According Coyne et al., past quality improvement studies showed that the institutions were not meeting the set standards for walk-in STEMI patients. Consequently, the researchers investigated potential impacts of simple, directed alterations in the emergency department triage activity for possible cardiac patients on reducing door-to-ECG times and then door-to-balloon times. The researchers established a main complaint-driven cardiac triage procedure and streamlined ECG completion. As such, the emergency department carefully assessed walk-in STEMI patients. It was concluded that there was significant reduction in door-to-balloon time, as well as a decline in the changeability of time sensitive durations of “door-to-ECG and ECG-to-balloon time” (p. 184).
Ellahham, S., Aljabbari, S., Mananghaya, T. H., Raji, S. J., & Zubaidi, A. A. (2015). Reducing Door-to-Balloon Time for Acute ST Elevation Myocardial Infarction In Primary Percutaneous Intervention: Transformation using Robust Performance Improvement. BMJ Quality Improvement Programme, 4(1), 1-4. Web.
Cardiovascular diseases are responsible for most deaths in the UAE and, therefore, immediate reperfusion availability is imperative for STEMI patients because of increased risks of death. A timely primary percutaneous coronary intervention (PCI) can reduce the risk. The guidelines promote less than 90 minutes between hospital arrival and intracoronary balloon inflation (door-to-balloon (D2B) time) during primary PCI.
The researchers noted that effective implementation of the Lean Six Sigma methodology could be used to decrease the door-to-balloon time for STEMI patients who are received through the emergency department. It resulted into leaner, improved efficiency and lesser variable and subsequently led to improved patient safety, quality care, and patient experience.
Flynn, A., Moscucci, M., Share, D., Smith, D., LaLonde, T., Changezi, H.,… Gurm, H. S. (2010). Trends in Door-to-Balloon Time and Mortality in Patients With ST- Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Archives of Internal Medicine, 170(20), 1842-1849. Web.
The available guidelines for reperfusion therapy involving DTB have insisted on not more than 90 minutes. Consequently, much effort is directed at lessening the DTB time with the postulation that a decline in DTB would result in a notable reduction in mortality. Patients at high risk have been the focus for immediate interventions through improved compliance with various national guidelines. However, no evidence is currently available to ascertain clinical outcomes. Conversely, the researchers further established that a dramatic decline in average DTB time and enhanced compliance did not translate to expected patient survival outcomes.
Jain, S. K., Ismail, Y., Shaw, M., David, S., & Alexander, P. (2012). “Register and Roll”: A Novel Initiative to Improve First Door-to-Balloon Time in ST Elevation Myocardial Infarction. Cardiology Research and Practice, 2012, 1-4. Web.
The authors investigated how causes of transfer delays in STEMI patients to PCI capable facilities affected outcomes. Delays were rampant when hospital transfers were required. They concluded that the use of Register and Roll was effective in streamlining the triage protocol and enhancing hospital transfer periods. It was further observed that the Register and Roll were easy to initiate and reliable, specifically in healthcare settings with limited resources.
Mehta, S., Oliveros, E., Alfonso, C. E., Falcão, E., Shamshad, F., Flores, A. I., & Cohen, S. (2009). Optimizing door-to-balloon times for STEMI interventions – Results from the SINCERE database. Journal of the Saudi Heart Association, 21(4), 229–243. Web.
To reduce mortality cases associated with STEMI, and augment outstanding long-term results in STEMI patients, intervention must be done expediently. For the best results, primary angioplasty must be performed within 90 min as recommended by practice guidelines.
Mehta et al. suggested that hospitals should have standardized techniques in administering PPCI, factoring in the need for systematic and careful approach to each case. Further, the authors recommended preference of PPCI to thrombotic therapy due to its relative effectiveness. As such, intervention should be done within D2B times while upholding excellence in caregiving and having long-term outcomes.
Wachira, B., Owuor, A., & Otieno, H. (2014). Acute management of ST-elevation myocardial infarction in a tertiary hospital in Kenya: are we complying with practice guidelines? African Journal of Emergency Medicine, 4(3), 1-5.
Most of the contemporary practice guidelines highly recommend swift reperfusion of STEMI patients. According to evidence-based practice guideline stipulations, delays for fibrinolysis and PCI should be maximum of 30 min and 90 min respectively.
In an attempt to evaluate the level of hospitals compliance to these guidelines, Wachira et al. however found that delays longer than recommended were evident.
The team, therefore, observed that there was need for hospitals to improve critical care system, especially in resource-limited locations, working within D2B times. This will help to improve the number of cases given timely intervention, especially in the developing world where less than half STEMI cases are attended within the D2B times.