Strategies to reduce time delays in patients with acute coronary heart disease treated with primary PCI. The STOP WATCH study

Abstract

Background: Though rapid coronary reperfusion reduces mortality in patients with ST-elevation myocardial infarction (STEMI), reperfusion therapy continues to be administered to late. A six-year action research study was conducted to reduce healthcare delay through multiple intervention activities. Objectives: We hypothesized that identification of delays followed by targeted reorganisation of logistics and personal feedback on delays to staff involved in STEMI care would lead to a reduction in healthcare delay time. The aim with the study was to identify and evaluate system delay times in a STEMI network. Design and setting: The study was carried out between 2006 and 2011 in one University hospital in Sweden and designed as a multistage action research project. Three study phases were used; exploration (pre-intervention phase), tailored intervention, and evaluation (post-intervention phase). Methods and interventions: Areas of delays were identified through participant observations and collaborative discussions with leading physicians in the network and representatives from the Emergency Medical System (EMS). Awareness of the delay factor and time is muscle was performed through repetitive meetings and continuous feedback on delays. Interventions done were 1) prioritised ECG recording by EMS personnel, 2) central evaluation of ECG in all patients with suspected STEMI, and 3) start of PCI procedure when two out of three PCI team members were on site. Multiple point measurements was done in patients admitted with STEMI for primary Percutaneous Coronary Intervention (PCI) before (N=67) and after (N=89) the intervention. Results: Time from ECG to decision for primary PCI was reduced by 6 minutes, p=0.004 and from ECG to cath-lab arrival by 11 minutes, p=0.02. Time from First Medical Contact (FMC) to a patent artery and from FMC-to-cath-lab arrival decreased by 6 and 12 minutes respectively (ns). Conclusion: Action research can be used as an effective tool to identify delays in a STEMI network and contribute to awareness of delay factors and facilitate reorganisation of logistics. Together with continuous feedback on delays that stimulates reflective clinical behaviour system delay times could be reduced significantly.