Abstract P135: An Independent Initiative to Improve Door-to-Balloon Times: Results From the Aurora 24x7 STEMI Program

Abstract

BACKGROUND: To improve hospital performance in door-to-balloon (D2B) times, an independent initiative - the Aurora St. Luke's 24x7 STEMI (ST-segment elevation myocardial infarction) program - was launched on April 1, 2004, as part of a system-wide quality improvement effort. We evaluated recent changes in D2B times within the program. METHODS: The program involves 24 hours a day, 7 days a week in-hospital call for the interventional cardiologist and the cardiac catheterization laboratory (CCL) staff and includes the following strategies: 1) rapid electrocardiogram acquisition and emergency department (ED) physician interpretation in ≤10 min of hospital arrival; 2) ED physician activation of the 24x7 team with a single call; 3) calibration of the clocks in the ED and the CCL checked monthly; and 4) feedback provided to staff within 24-72 hours. We studied D2B times in non-transferred patients with STEMI treated with primary PCI (PPCI) from July 2007 to June 2009. RESULTS: A total of 251 consecutive non-transfer patients (median age 60, women 30.7% [77 of 251]) underwent PPCI for acute STEMI. Median D2B was 52 min (interquartile range 41-64) with a 93.6% (n=235 of 251) rate of D2B <90 min. Secondary analyses of this cohort demonstrated a 69.3% rate (175 of 251) of D2B <60 min. CONCLUSION: An innovative in-hospital 24x7 interventional STEMI program has dramatically increased the percentage of patients reperfused within 90 min and consistently exceeds the American College of Cardiology Door-to-Balloon (D2B) Alliance benchmark (93.6% vs. 75% rate of D2B <90 min). The 24x7 STEMI program is an important demonstration model in systems improvement for care of patients with STEMI.