IMPROVING DOOR TO BALLOON TIME IN PATIENTS WITH STEMI IN THE EMERGENCY DEPARTMENT BY IMPLEMENTING CLINICAL CODE

Dr Rupesh Purushottam Bokade; Dr Kayanoosh Kadapatti; Dr Sayed Fiyaz Pasha

Volume : VIII, Issue : XI, November - 2019

IMPROVING DOOR TO BALLOON TIME IN PATIENTS WITH STEMI IN THE EMERGENCY DEPARTMENT BY IMPLEMENTING CLINICAL CODE "CARDIAC ALERT"

Dr Rupesh Purushottam Bokade, Dr Kayanoosh Kadapatti, Dr Sayed Fiyaz Pasha

Abstract :

INTRODUCTION: Over the past 25 years, the survival of patients with ST–segment elevation myocardial infarction (STEMI) has improved substantially, with the development of thrombolytic therapy, primary percutaneous coronary intervention (PCI), and improvements in adjunctive medical therapy. During the past decade, primary PCI has become the preferred treatment strategy when experienced operators and hospitals are available within an appropriate time frame.For both primary PCI and thrombolytic therapy, analyses have consistently shown that timeliness of reperfusion is a major prognostic factor in improving patient survival. For PCI, the American College of Cardiology has recommended a delay of no more than 90 minutes from initial hospital contact to first balloon inflation. METHODS: CARDIAC ALERT code was implemented and included activation of cardiac catheterization laboratory by emergency medicine physician. We retrospectively reviewed 190 patients with a diagnosis of STEMI, a period of time before and after implementation of a clinical code aimed at reducing door to balloon time. RESULTS: Door to balloon time was compared between groups before (n=95),and after (n=95)clinical code implementation. Median door to balloon time for the former group was 129.73 minutes and for the latter group 70 minutes. Prior to implementation of protocol a door to balloon time of <90 minutes was achieved in 15.6% of cases.By the end of study, this goal was being met in 90.5%. CONCLUSION:This observational study provides support for the use of Clinical Code CARDIAC ALERT as a key for reduction in door to balloon time. Our experience demonstrates extensive interdisciplinary collaboration and explicit strategies for overcoming the barriers to organizational change.