For many patients with ST-segment elevation myocardial infarctions (STEMIs), the time
from presentation to percutaneous coronary intervention exceeds established goals.
This study was conducted to examine the effects of formalized data assessment and
systematic feedback on treatment times. All patients with STEMIs treated with percutaneous
coronary intervention in a semirural 3-hospital network from January 1, 2006, to December
31, 2006, were prospectively analyzed (n = 114). Patients presenting during the first
3-month period (January 1, 2006, to March 31, 2006) were included as the reference
group (n = 33). Time points from initial contact with the medical system to revascularization
were assessed, analyzed, and presented in an interactive session to hospital and emergency
services staff members. Data from patients with STEMIs presenting during the next
3 quarters were presented in the same manner (n = 28, 25, and 28). The median contact-to-balloon
time was 113 minutes in the reference quarter, decreasing to 83, 66, and 74 minutes
in the intervention groups (p <0.0001), whereas the median door-to-balloon time decreased
from 54 minutes in the reference group to 35, 31, and 26 minutes in the intervention
groups (p <0.0001). The proportion of patients with contact-to-balloon times <90 minutes
increased from 21% to 79% (p <0.0001). There were significant reductions in the durations
of initial treatment on location and in the emergency room and in puncture-to-balloon-time
in the catheterization laboratory, and more patients were transported directly to
the catheterization laboratory, bypassing the emergency room (from 23% in the reference
quarter to 76% in the last intervention quarter, p <0.0001). In conclusion, formalized
data feedback leads to marked reduction in revascularization times in patients with
STEMIs.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Strategies for reducing the door-to-balloon time in acute myocardial infarction.N Engl J Med. 2006; 355: 2308-2320
- Feedback and Organization Development: Using Data-Based Methods.Addison-Wesley, New York, New York1977
- Continuous improvement as an ideal in health care.N Engl J Med. 1989; 320: 53-56
- Data feedback efforts in quality improvement: lessons learned from US hospitals.Qual Saf Health Care. 2004; 13: 26-31
- Implementation of a continuous quality improvement program for percutaneous coronary intervention and cardiac surgery at a large community hospital.Am Heart J. 2006; 152: 379-385
- Improving the quality of care for Medicare patients with acute myocardial infarction: results from the Cooperative Cardiovasular Project.JAMA. 1998; 279: 1351-1357
- Effect of local medical opinion leaders on quality of care for acute myocardial infarction: a randomized controlled trial.JAMA. 1998; 279: 1358-1363
- Data feedback and clinical process improvement in acute myocardial infarction.Am Heart J. 2005; 149: 856-861
- Quality improvement efforts and hospital performance: rates of beta-blocker prescription after acute myocardial infarction.Med Care. 2005; 43: 282-292
- Improving pharmacotherapy after myocardial infarction by group academic detailing using feedback data on patient level.Pharmacotherapy. 2006; 26: 254-259
- Achieving rapid door-to-balloon times: how top hospitals improve complex clinical systems.Circulation. 2006; 113: 1079-1085
- Door-to-balloon time in primary percutaneous coronary intervention—is the 90-minute gold standard an unreachable chimera?.Circulation. 2006; 113: 1048-1050
- Reducing the door-to-balloon time for myocardial infarction with ST-segment elevation.N Engl J Med. 2006; 355: 2364-2365
- Use of emergency medical services in acute myocardial infarction and subsequent quality of care: observations from the National Registry of Myocardial Infarction 2.Circulation. 2002; 106: 3018-3023
- The pre-hospital electrocardiogram and time to reperfusion in patients with acute myocardial infarction, 2000-2002: findings from the National Registry of Myocardial Infarction-4.J Am Coll Cardiol. 2006; 47: 1544-1552
Article info
Publication history
Published online: November 16, 2007
Accepted:
July 13,
2007
Received in revised form:
July 13,
2007
Received:
May 30,
2007
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.