Emergency department physician activation of the catheterization laboratory and immediate transfer to an immediately available catheterization laboratory reduce door-to-balloon time in ST-elevation myocardial infarction

Article

关键词: QUALITY IMPROVEMENT ANALYSIS;    CORONARY ANGIOPLASTY;    SEGMENT ELEVATION;    AMERICAN-COLLEGE;    CARE;    PERFORMANCE;    REPERFUSION;    HOSPITALS;    MORTALITY;    DELIVERY;   

DOI  :  10.1161/CIRCULATIONAHA.106.677401

来源: SCIE

【 摘 要 】

Background - Consensus guidelines and hospital quality-of-care programs recommend that ST-elevation myocardial infarction patients achieve a door-to-balloon time of <= 90 minutes. However, there are limited prospective data on specific measures to significantly reduce door-to-balloon time. Methods and Results - We prospectively determined the impact on median door-to-balloon time of a protocol mandating (1) emergency department physician activation of the catheterization laboratory and (2) immediate transfer of the patient to an immediately available catheterization laboratory by an in-house transfer team consisting of an emergency department nurse, a critical care unit nurse, and a chest pain unit nurse. We collected door- to- balloon time for 60 consecutive ST-elevation myocardial infarction patients undergoing emergency percutaneous intervention within 24 hours of presentation from October 1, 2004, through August 31, 2005, and compared this group with 86 consecutive ST-elevation myocardial infarction patients from September 1, 2005, through June 26, 2006, after protocol implementation. Median door-to-balloon time decreased overall (113.5 versus 75.5 minutes; P < 0.0001), during regular hours (83.5 versus 64.5 minutes; P = 0.005), during off-hours (123.5 versus 77.5 minutes; P < 0.0001), and with transfer from an outside affiliated emergency department (147 versus 85 minutes; P = 0.0006). Treatment within 90 minutes increased from 28% to 71% (P < 0.0001). Mean infarct size decreased (peak creatinine kinase, 2623 +/- 3329 versus 1517 +/- 1556 IU/L; P = 0.0089), as did hospital length of stay (5 +/- 7 versus 3 +/- 2 days; P = 0.0097) and total hospital costs per admission ($26 826 +/- 29 497 versus $18 280 +/- 8943; P = 0.0125). Conclusions - Emergency department physician activation of the catheterization laboratory and immediate transfer of the patient to an immediately available catheterization laboratory reduce door- to- balloon time, leading to a reduction in myocardial infarct size, hospital length of stay, and total hospital costs.

【 授权许可】

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