Effectiveness of a Myocardial Infarction Protocol in Reducing Door-to-Ballon Time

Abstract

BackgroundAn adequate door-to-balloon time (<120 minutes) is the necessary condition for the efficacy of primary angioplasty in infarction to translate into effectiveness. ObjectiveTo describe the effectiveness of a quality of care protocol in reducing the door-to-balloon time. MethodsBetween May 2010 and August 2012, all individuals undergoing primary angioplasty in our hospital were analyzed. The door time was electronically recorded at the moment the patient took a number to be evaluated in the emergency room, which occurred prior to filling the check-in forms and to the triage. The balloon time was defined as the beginning of artery opening (introduction of the first device). The first 5 months of monitoring corresponded to the period of pre-implementation of the protocol. The protocol comprised the definition of a flowchart of actions from patient arrival at the hospital, the team's awareness raising in relation to the prioritization of time, and provision of a periodic feedback on the results and possible inadequacies. ResultsA total of 50 individuals were assessed. They were divided into five groups of 10 sequential patients (one group pre-and four groups post-protocol). The door-to-balloon time regarding the 10 cases recorded before protocol implementation was 200 ± 77 minutes. After protocol implementation, there was a progressive reduction of the door-to-balloon time to 142 ± 78 minutes in the first 10 patients, then to 150 ± 50 minutes, 131 ± 37 minutes and, finally, 116 ± 29 minutes in the three sequential groups of 10 patients, respectively. Linear regression between sequential patients and the door-to-balloon time (r = - 0.41) showed a regression coefficient of - 1.74 minutes. ConclusionThe protocol implementation proved effective in the reduction of the door-to-balloon time.