Reducing D2B Time in AMI
The Article: Strategies for Reducing the Door-to-Balloon Time in Acute Myocardial Infarction. EH Bradley et al. N Engl J Med 2006;355:2308-20.
The Goal: To determine whether 28 specific strategies were associated with significantly faster D2B times.
The Study: A cross sectional study of hospitals reporting D2B times to the Centers for Medicare and Medicaid. 500 hospitals were sent a web-based survey of multiple choice questions about their D2B strategies and policies. The outcome was D2B times for patients with STEMI who underwent PCI at these hospitals.
The Findings: 365/500 hospitals responded for a 73% response rate. Mean D2B time was 100.4 minutes overall. Six of the 28 strategies were associated with significantly faster D2B times:
Having EM physicians activate the cath lab (mean reduction in D2B time 8.2 minutes)
Having a single call to a central page operator to activate the cath lab (13.8 mins)
Having the emergency department activate the cath lab while the patient is en route to the hospital (15.4 mins)
Expecting cath lab staff to arrive within 20 mins of being paged (19.3 mins)
Having an attending cardiologist always on site (14.6 mins)
Having emergency department staff and cath lab staff use real time feedback (8.6 mins)
Hospitals with increasing numbers of these 6 key strategies had progressively shorter median D2B times. There were few “false alarm” cath lab activations when EM physicians and pre-hospital D2Bs were called.
The Takeaway: Specific practices can significantly reduce D2B times about 10-15 minutes. This is especially clinically important when the critical benchmark is 90 minutes, and this group of hospitals had a mean D2B time of 100.4 minutes.