The current door-to-balloon time guideline for ST-elevation myocardial infarction patients from the American Heart Association is 90 minutes or less.
Many hospitals around the country have taken steps to reduce their STEMI times, and save more lives. The best practices of these high-performing hospitals help keep STEMI response times low, and survival rates high.
Memorial Hospital (Chattanooga, Tenn.)
Average door-to-balloon time: 45.9 minutes
"We've worked really hard to drive our response times down," says Eric Conn, MD, of the Chattanooga Heart Institute, located on the hospital's main campus. "We've looked at every case to see where we can shave off minutes," he says.
Because of all the different clinicians and response teams involved in treating a STEMI patient, reducing response times and keeping times low is a truly multidisciplinary effort, he says. "We've analyzed each segment of the process to get the times down," and focused on improving communication between all segments to streamline the process, he says.
Memorial Hospital is also partnering with local EMS personnel to perform ECGs and send results electronically to physicians at the Heart Institute, says Dr. Conn, so the staff has advance notice of the condition and time to set up the catheterization lab. "By bypassing the emergency room and having the patient brought directly to the cath lab, we can shave off a lot of time," he says.
Though they have had significant successes, Memorial Hospital continues to work toward shorter response times. "Mortality rate for these patients is directly proportional to time," says Dr. Conn. "We need to figure out ways to keep doing this better."
University Hospital Case Medical Center (Cleveland)
Median door-to-balloon time: 42 minutes
"The most important thing to do is partner with local EMTs, paramedics [and] fire departments" to reduce door-to-balloon times, says Todd Harford, RN, director of invasive cardiology at University Hospital Case Medical Center. He advocates focusing on educating the first responders on the importance of performing an ECG in the field and sending the results electronically to the emergency department for physician review so the medical staff can be ready for STEMI patients.
Mr. Harford says his hospital's partnership with local first responders is "at the point where if they look at the ECG and think it's a STEMI, we trust them and activate our teams based off their interpretations." It saves a lot of time, he says, when the catheterization lab can start being prepared ahead of the patient's arrival.
Another significant timesaver for Case Medical Center is their one-call system. "We make one call or one page, and it sends out multiple pages to all the different people that need to be involved in the STEMI patient's care," says Mr. Harford. When the page comes in, "they know to come in immediately," he says. To further improve response time, the hospital's staff members are geolocated so that at least two staff members called are within a 30 minute radius of the hospital, he says.
OSF Saint Francis Medical Center (Peoria, Ill.)
Median door-to-balloon time: 42 minutes
To improve STEMI response times, OSF HealthCare donated funds to EMS agencies and local hospitals that don't perform STEMI procedures to be put towards the acquisition of pre-hospital ECG technology that ensures rapid and reliable ECG transmission without relying on cell phone networks. With this technology first responders are able to perform an ECG and send the results electronically to an OSF facility so hospital physicians have time to prepare. Using this system, "we have been able to initiate the STEMI protocol from the field" and significantly reduce response times, says Darrel Gumm, MD, OSF ministry-wide coronary artery disease physician champion.
"The single most important item was instituting [this technology] for reliable transmission of pre-hospital ECG's," says John Rashid, MD, the STEMI physician champion at OSF Saint Francis.
For patients brought by paramedics who do not have the pre-hospital ECG technology, emergency department physicians trust the ECG interpretation of the field paramedic, says Mary Brown, RN, cardiac program coordinator at OSF Saint Francis. "No one gets upset" if the patient is discovered to not have a STEMI, as "no harm is done by activating too often," she says. "We say err on the side of the patient."
Dr. Rashid also cites the team at OSF Saint Francis for the hospital's success in keeping STEMI response times low. "I don’t think my technique is any different" than other cardiologists, he says, but another cardiologist's team "cannot match mine… nobody shirks their responsibility, and all are acutely attuned to the needs of the patient."