Emergency physician discretion to activate the cardiac catheterization team decreases door-to-balloon time for acute ST-elevation myocardial infarction

Study objective: The national standard for door-to-balloon time is 90 minutes, as recommended by the American Heart Association/American College of Cardiology guidelines for ST-elevation myocardial infarction (STEMI). Percutaneous coronary intervention for STEMI was initiated at our institution in June 2004. Review of our door-to-balloon times revealed that we were not meeting this recommendation. We determine whether concurrent rather than serial activation of the cardiac catheterization personnel and interventional cardiologist by the emergency physician would improve door-to-balloon times in the community hospital setting. Methods: We conducted a retrospective before-and-after study from June 2004 to June 2005 to evaluate this protocol change. In November 2004, a revised STEMI protocol went into effect at our community hospital that called for concurrent activation of the cardiac catheterization personnel and the interventional cardiologist by the emergency physician. No other changes were made to our protocol or personnel during this time. The mean door-to-balloon time for the 6 months before our intervention was then compared to the mean door-to-balloon time for the following 6 months. Results: During the 6-month period before protocol revision, the average door-to-balloon time for the 37 STEMI patients was 147 minutes. After the protocol was revised, the average door-to-balloon time for the 51 patients in the concurrent activation group was 106 minutes, a decrease of 41 minutes (95% confidence interval 21 to 61 minutes). Conclusion: At our community hospital, concurrent activation of the cardiac catheterization team and the interventional cardiologist by the emergency physician significantly decreases door-to-balloon time for acute STEMI.