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Summary of evidence regarding hospital strategies to reduce door-to-balloon times for patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
Crit Pathw Cardiol. 2007 Sep; 6(3):91-7.CP

Abstract

Despite the clinical importance of prompt percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction, many hospitals do not routinely achieve the guideline-recommended 90-minute door-to-balloon times. In this review, we evaluate existing evidence that identifies effective hospital strategies for reducing door-to-balloon time. We performed a computerized search of MEDLINE and Current Contents for studies conducted in the last 10 years of hospital efforts to improve door-to-balloon times. We excluded studies that had <10 patients, had nonspecific efforts, or, for quantitative studies, lacked statistical tests; each study was independently evaluated by 3 researchers. We found 13 studies that examined the relationship between hospital-based strategies and door-to-balloon times. Three examined national samples of hospitals using cross-sectional designs; 8 were conducted in a single or small number of hospitals using pre/post interventional or cross-sectional designs, and 2 were qualitative in design. Strategies with the strongest evidence include (1) activation of the catheterization laboratory using emergency medicine physicians rather than cardiologists, (2) effective use of prehospital electrocardiograms, (3) performance data monitoring/feedback. Reasonable evidence exists for establishing a single-call system for activating the catheterization laboratory, setting the expectation that the catheterization team be available 20-30 minutes after being paged, and having an organizational environment with strong senior management support and culture to foster changes directed at improving door-to-balloon time. In conclusion, although evidence of "what works" is based on observational studies rather than randomized trials, there is evidence on effective interventions to reduce door-to-balloon time.

Authors+Show Affiliations

Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, N.I.H., Extramural
Review

Language

eng

PubMed ID

17804968

Citation

Bradley, Elizabeth H., et al. "Summary of Evidence Regarding Hospital Strategies to Reduce Door-to-balloon Times for Patients With ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention." Critical Pathways in Cardiology, vol. 6, no. 3, 2007, pp. 91-7.
Bradley EH, Nallamothu BK, Curtis JP, et al. Summary of evidence regarding hospital strategies to reduce door-to-balloon times for patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Crit Pathw Cardiol. 2007;6(3):91-7.
Bradley, E. H., Nallamothu, B. K., Curtis, J. P., Webster, T. R., Magid, D. J., Granger, C. B., Moscucci, M., & Krumholz, H. M. (2007). Summary of evidence regarding hospital strategies to reduce door-to-balloon times for patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Critical Pathways in Cardiology, 6(3), 91-7.
Bradley EH, et al. Summary of Evidence Regarding Hospital Strategies to Reduce Door-to-balloon Times for Patients With ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Crit Pathw Cardiol. 2007;6(3):91-7. PubMed PMID: 17804968.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Summary of evidence regarding hospital strategies to reduce door-to-balloon times for patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. AU - Bradley,Elizabeth H, AU - Nallamothu,Brahmajee K, AU - Curtis,Jeptha P, AU - Webster,Tashonna R, AU - Magid,David J, AU - Granger,Christopher B, AU - Moscucci,Mauro, AU - Krumholz,Harlan M, PY - 2007/9/7/pubmed PY - 2007/9/28/medline PY - 2007/9/7/entrez SP - 91 EP - 7 JF - Critical pathways in cardiology JO - Crit Pathw Cardiol VL - 6 IS - 3 N2 - Despite the clinical importance of prompt percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction, many hospitals do not routinely achieve the guideline-recommended 90-minute door-to-balloon times. In this review, we evaluate existing evidence that identifies effective hospital strategies for reducing door-to-balloon time. We performed a computerized search of MEDLINE and Current Contents for studies conducted in the last 10 years of hospital efforts to improve door-to-balloon times. We excluded studies that had <10 patients, had nonspecific efforts, or, for quantitative studies, lacked statistical tests; each study was independently evaluated by 3 researchers. We found 13 studies that examined the relationship between hospital-based strategies and door-to-balloon times. Three examined national samples of hospitals using cross-sectional designs; 8 were conducted in a single or small number of hospitals using pre/post interventional or cross-sectional designs, and 2 were qualitative in design. Strategies with the strongest evidence include (1) activation of the catheterization laboratory using emergency medicine physicians rather than cardiologists, (2) effective use of prehospital electrocardiograms, (3) performance data monitoring/feedback. Reasonable evidence exists for establishing a single-call system for activating the catheterization laboratory, setting the expectation that the catheterization team be available 20-30 minutes after being paged, and having an organizational environment with strong senior management support and culture to foster changes directed at improving door-to-balloon time. In conclusion, although evidence of "what works" is based on observational studies rather than randomized trials, there is evidence on effective interventions to reduce door-to-balloon time. SN - 1535-2811 UR - https://www.unboundmedicine.com/medline/citation/17804968/Summary_of_evidence_regarding_hospital_strategies_to_reduce_door_to_balloon_times_for_patients_with_ST_segment_elevation_myocardial_infarction_undergoing_primary_percutaneous_coronary_intervention_ L2 - https://doi.org/10.1097/HPC.0b013e31812da7bc DB - PRIME DP - Unbound Medicine ER -