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Sustaining improvement in door-to-balloon time over 4 years: the Mayo clinic ST-elevation myocardial infarction protocol.
Circ Cardiovasc Qual Outcomes. 2009 Sep; 2(5):508-13.CC

Abstract

BACKGROUND

American College of Cardiology/American Heart Association guidelines recommend a door-to-balloon time (DTB) <90 minutes for nontransferred patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention. Systems of care to achieve and sustain this DTB performance over several years have not been previously reported.

METHODS AND RESULTS

The Mayo Clinic STEMI protocol was implemented in April 2004 and included activation of the cardiac catheterization laboratory by the emergency medicine physician; a single call system to activate the catheterization laboratory; catheterization laboratory staff arrival within 20 to 30 minutes of activation; and real-time performance feedback within 24 to 48 hours. Data were collected on nontransferred STEMI patients. The preimplementation group (June 2002 to March 2004) comprised 96 patients with a median DTB of 97 (interquartile range, 82, 130) minutes, and 40% had a DTB <90 minutes. The postimplementation group (May 2004 to March 2008) comprised 322 patients with a median DTB of 67 (interquartile range, 55, 82) minutes, and 81% had a DTB <90 minutes. Postimplementation DTB was significantly shorter than preimplementation DTB (P<0.001). In the 4-year follow-up after protocol implementation, the DTB performance remained stable over time (P=0.41).

CONCLUSIONS

The Mayo Clinic STEMI protocol implemented strategies to reduce DTB for nontransferred patients with STEMI. DTB was significantly reduced, and the results were sustained over the 4-year follow-up period. Our experience demonstrates the effectiveness and durability of process changes targeting timeliness of primary percutaneous coronary intervention.

Authors+Show Affiliations

Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA. nestler.david@mayo.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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

Language

eng

PubMed ID

20031884

Citation

Nestler, David M., et al. "Sustaining Improvement in Door-to-balloon Time Over 4 Years: the Mayo Clinic ST-elevation Myocardial Infarction Protocol." Circulation. Cardiovascular Quality and Outcomes, vol. 2, no. 5, 2009, pp. 508-13.
Nestler DM, Noheria A, Haro LH, et al. Sustaining improvement in door-to-balloon time over 4 years: the Mayo clinic ST-elevation myocardial infarction protocol. Circ Cardiovasc Qual Outcomes. 2009;2(5):508-13.
Nestler, D. M., Noheria, A., Haro, L. H., Stead, L. G., Decker, W. W., Scanlan-Hanson, L. N., Lennon, R. J., Lim, C. C., Holmes, D. R., Rihal, C. S., Bell, M. R., & Ting, H. H. (2009). Sustaining improvement in door-to-balloon time over 4 years: the Mayo clinic ST-elevation myocardial infarction protocol. Circulation. Cardiovascular Quality and Outcomes, 2(5), 508-13. https://doi.org/10.1161/CIRCOUTCOMES.108.839225
Nestler DM, et al. Sustaining Improvement in Door-to-balloon Time Over 4 Years: the Mayo Clinic ST-elevation Myocardial Infarction Protocol. Circ Cardiovasc Qual Outcomes. 2009;2(5):508-13. PubMed PMID: 20031884.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sustaining improvement in door-to-balloon time over 4 years: the Mayo clinic ST-elevation myocardial infarction protocol. AU - Nestler,David M, AU - Noheria,Amit, AU - Haro,Luis H, AU - Stead,Latha G, AU - Decker,Wyatt W, AU - Scanlan-Hanson,Lori N, AU - Lennon,Ryan J, AU - Lim,Choon-Chern, AU - Holmes,David R,Jr AU - Rihal,Charanjit S, AU - Bell,Malcolm R, AU - Ting,Henry H, PY - 2009/12/25/entrez PY - 2009/12/25/pubmed PY - 2010/3/18/medline SP - 508 EP - 13 JF - Circulation. Cardiovascular quality and outcomes JO - Circ Cardiovasc Qual Outcomes VL - 2 IS - 5 N2 - BACKGROUND: American College of Cardiology/American Heart Association guidelines recommend a door-to-balloon time (DTB) <90 minutes for nontransferred patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention. Systems of care to achieve and sustain this DTB performance over several years have not been previously reported. METHODS AND RESULTS: The Mayo Clinic STEMI protocol was implemented in April 2004 and included activation of the cardiac catheterization laboratory by the emergency medicine physician; a single call system to activate the catheterization laboratory; catheterization laboratory staff arrival within 20 to 30 minutes of activation; and real-time performance feedback within 24 to 48 hours. Data were collected on nontransferred STEMI patients. The preimplementation group (June 2002 to March 2004) comprised 96 patients with a median DTB of 97 (interquartile range, 82, 130) minutes, and 40% had a DTB <90 minutes. The postimplementation group (May 2004 to March 2008) comprised 322 patients with a median DTB of 67 (interquartile range, 55, 82) minutes, and 81% had a DTB <90 minutes. Postimplementation DTB was significantly shorter than preimplementation DTB (P<0.001). In the 4-year follow-up after protocol implementation, the DTB performance remained stable over time (P=0.41). CONCLUSIONS: The Mayo Clinic STEMI protocol implemented strategies to reduce DTB for nontransferred patients with STEMI. DTB was significantly reduced, and the results were sustained over the 4-year follow-up period. Our experience demonstrates the effectiveness and durability of process changes targeting timeliness of primary percutaneous coronary intervention. SN - 1941-7705 UR - https://www.unboundmedicine.com/medline/citation/20031884/Sustaining_improvement_in_door_to_balloon_time_over_4_years:_the_Mayo_clinic_ST_elevation_myocardial_infarction_protocol_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.108.839225?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -