IMPROVING DOOR TO BALLOON TIME IN PATIENTS WITH STEMI IN THE EMERGENCY DEPARTMENT BY IMPLEMENTING CLINICAL CODE "CARDIAC ALERT"

Abstract

INTRODUCTION: Over the past 25 years, the survival of patients with ST-segment elevation myocardial infarction (STEMI) has improved
substantially, with the development of thrombolytic therapy, primary percutaneous coronary intervention (PCI), and improvements in adjunctive
medical therapy. During the past decade, primary PCI has become the preferred treatment strategy when experienced operators and hospitals are
available within an appropriate time frame.For both primary PCI and thrombolytic therapy, analyses have consistently shown that timeliness of
reperfusion is a major prognostic factor in improving patient survival. For PCI, the American College of Cardiology has recommended a delay of
no more than 90 minutes from initial hospital contact to first balloon inflation.
METHODS: CARDIAC ALERT code was implemented and included activation of cardiac catheterization laboratory by emergency medicine
physician. We retrospectively reviewed 190 patients with a diagnosis of STEMI, a period of time before and after implementation of a clinical code
aimed at reducing door to balloon time.
RESULTS: Door to balloon time was compared between groups before (n=95),and after (n=95)clinical code implementation. Median door to
balloon time for the former group was 129.73 minutes and for the latter group 70 minutes. Prior to implementation of protocol a door to balloon
time of <90 minutes was achieved in 15.6% of cases.By the end of study, this goal was being met in 90.5%.
CONCLUSION: This observational study provides support for the use of Clinical Code CARDIAC ALERT as a key for reduction in door to
balloon time. Our experience demonstrates extensive interdisciplinary collaboration and explicit strategies for overcoming the barriers to
organizational change.