Improving door-to-balloon times in primary percutaneous coronary intervention for acute ST-elevation myocardial infarction: the value of an audit-driven quality initiative.

Charles, Rabind A; Wee, Shiou Liang; Kwok, Bernard W K; Tan, Caren; Lim, Swee Han; Anantharaman, Venkataraman; Hemanthakumari, Wasantha; Chua, Terrance S J

INTRODUCTION The study was designed to reduce door-to-balloon times in primary percutaneous coronary intervention for patients presenting to the Emergency Department with acute ST-elevation myocardial infarction, using an audit as a quality initiative. MATERIALS AND METHODS A multidisciplinary work group performed a pilot study over 3 months, then implemented various process and work-flow strategies to improve overall door-to-balloon times. RESULTS AND CONCLUSION We developed a guideline-based, institution-specific written protocol for triaging and managing patients who present to the Emergency Department with symptoms suggestive of STEMI, resulting in shortened median door-to-balloon times from 130.5 to 109.5 minutes (P<0.001).