Ongoing Audit and Process Change Improves Door to Balloon Time for ST-elevation Myocardial Infarction at a Tertiary Australian Hospital

Abstract

Background: Door to balloon time (DTBT) is a key indicator of quality of care for ST-elevation myocardial infarction (STEMI) patients who receive primary PCI. National and international guidelines recommend a DTBT ≤90min. The goal of this audit was to identify sources of delay for STEMI patients at Austin Health, implement process change and evaluate the effect on DTBT. Method: An analysis of time specific data was performed on 326 consecutive STEMI patients that presented to the Emergency Department (ED) at Austin Health over a 39-month period. Interhospital transfer and interdepartmental STEMI cases were excluded. Sources of delay were identified and minimised. Sixteen months into the project, a process change called “Cath Lab Code” was implemented, involving ED activation and rapid access to cardiac services. An additional process involving prehospital ambulance activation and direct admission to the Cardiac Catheterisation Laboratory was implemented 14 months later. Results: Mean age was 63± 12 years with 24% female. Results were separated into three timeframes for comparison: Pre Cath Lab Code (n= 156), Post Cath Lab Code (n= 110) and Post Direct Admission (n= 60).MedianDTBT was 109, 77 and 76min respectively (P< 0.05). A DTBT of ≤90min was achieved in 34%, 58% and 67% of cases respectively. Conclusion: Implementation of two process changes produced substantial improvements in time to treatment with primary PCI for STEMI patients. An audit of time specific data continues to capture changes to DTBT and the impact on clinical outcomes is being evaluated.