Sustaining Improvement in Door-to-Balloon Time Over 4 Years: The Mayo Clinic ST-Elevation Myocardial Infarction Protocol

David M. Nestler, Amit Noheria, Luis H. Haro, Latha G. Stead, Wyatt W. Decker, Lori N. Scanlan-Hanson, Ryan J. Lennon, Choon Chern Lim, David Holmes, Charanjit Rihal, Malcolm R. Bell, Henry H. Ting

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background-American College of Cardiology/American Heart Association guidelines recommend a door-to-balloon time (DTB) <90 minutes for nontransferred patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention. Systems of care to achieve and sustain this DTB performance over several years have not been previously reported. Methods and Results-The Mayo Clinic STEMI protocol was implemented in April 2004 and included activation of the cardiac catheterization laboratory by the emergency medicine physician; a single call system to activate the catheterization laboratory; catheterization laboratory staff arrival within 20 to 30 minutes of activation; and real-time performance feedback within 24 to 48 hours. Data were collected on nontransferred STEMI patients. The preimplementation group (June 2002 to March 2004) comprised 96 patients with a median DTB of 97 (interquartile range, 82, 130) minutes, and 40% had a DTB <90 minutes. The postimplementation group (May 2004 to March 2008) comprised 322 patients with a median DTB of 67 (interquartile range, 55, 82) minutes, and 81% had a DTB <90 minutes. Postimplementation DTB was significantly shorter than preimplementation DTB (P<0.001). In the 4-year follow-up after protocol implementation, the DTB performance remained stable over time (P<0.41). Conclusions-The Mayo Clinic STEMI protocol implemented strategies to reduce DTB for nontransferred patients with STEMI. DTB was significantly reduced, and the results were sustained over the 4-year follow-up period. Our experience demonstrates the effectiveness and durability of process changes targeting timeliness of primary percutaneous coronary intervention. (Circ Cardiovasc Qual Outcomes. 2009;2:508-513.)

Original languageEnglish (US)
Pages (from-to)508-513
Number of pages6
JournalCirculation: Cardiovascular Quality and Outcomes
Volume2
Issue number5
DOIs
StatePublished - Sep 2009
Externally publishedYes

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Percutaneous Coronary Intervention
Catheterization
ST Elevation Myocardial Infarction
Emergency Medicine
Cardiac Catheterization
Guidelines
Physicians

Keywords

  • Diagnosis
  • Myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Sustaining Improvement in Door-to-Balloon Time Over 4 Years : The Mayo Clinic ST-Elevation Myocardial Infarction Protocol. / Nestler, David M.; Noheria, Amit; Haro, Luis H.; Stead, Latha G.; Decker, Wyatt W.; Scanlan-Hanson, Lori N.; Lennon, Ryan J.; Lim, Choon Chern; Holmes, David; Rihal, Charanjit; Bell, Malcolm R.; Ting, Henry H.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 2, No. 5, 09.2009, p. 508-513.

Research output: Contribution to journalArticle

Nestler, DM, Noheria, A, Haro, LH, Stead, LG, Decker, WW, Scanlan-Hanson, LN, Lennon, RJ, Lim, CC, Holmes, D, Rihal, C, Bell, MR & Ting, HH 2009, 'Sustaining Improvement in Door-to-Balloon Time Over 4 Years: The Mayo Clinic ST-Elevation Myocardial Infarction Protocol', Circulation: Cardiovascular Quality and Outcomes, vol. 2, no. 5, pp. 508-513. https://doi.org/10.1161/CIRCOUTCOMES.108.839225
Nestler, David M. ; Noheria, Amit ; Haro, Luis H. ; Stead, Latha G. ; Decker, Wyatt W. ; Scanlan-Hanson, Lori N. ; Lennon, Ryan J. ; Lim, Choon Chern ; Holmes, David ; Rihal, Charanjit ; Bell, Malcolm R. ; Ting, Henry H. / Sustaining Improvement in Door-to-Balloon Time Over 4 Years : The Mayo Clinic ST-Elevation Myocardial Infarction Protocol. In: Circulation: Cardiovascular Quality and Outcomes. 2009 ; Vol. 2, No. 5. pp. 508-513.
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abstract = "Background-American College of Cardiology/American Heart Association guidelines recommend a door-to-balloon time (DTB) <90 minutes for nontransferred patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention. Systems of care to achieve and sustain this DTB performance over several years have not been previously reported. Methods and Results-The Mayo Clinic STEMI protocol was implemented in April 2004 and included activation of the cardiac catheterization laboratory by the emergency medicine physician; a single call system to activate the catheterization laboratory; catheterization laboratory staff arrival within 20 to 30 minutes of activation; and real-time performance feedback within 24 to 48 hours. Data were collected on nontransferred STEMI patients. The preimplementation group (June 2002 to March 2004) comprised 96 patients with a median DTB of 97 (interquartile range, 82, 130) minutes, and 40{\%} had a DTB <90 minutes. The postimplementation group (May 2004 to March 2008) comprised 322 patients with a median DTB of 67 (interquartile range, 55, 82) minutes, and 81{\%} had a DTB <90 minutes. Postimplementation DTB was significantly shorter than preimplementation DTB (P<0.001). In the 4-year follow-up after protocol implementation, the DTB performance remained stable over time (P<0.41). Conclusions-The Mayo Clinic STEMI protocol implemented strategies to reduce DTB for nontransferred patients with STEMI. DTB was significantly reduced, and the results were sustained over the 4-year follow-up period. Our experience demonstrates the effectiveness and durability of process changes targeting timeliness of primary percutaneous coronary intervention. (Circ Cardiovasc Qual Outcomes. 2009;2:508-513.)",
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AU - Nestler, David M.

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AU - Haro, Luis H.

AU - Stead, Latha G.

AU - Decker, Wyatt W.

AU - Scanlan-Hanson, Lori N.

AU - Lennon, Ryan J.

AU - Lim, Choon Chern

AU - Holmes, David

AU - Rihal, Charanjit

AU - Bell, Malcolm R.

AU - Ting, Henry H.

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N2 - Background-American College of Cardiology/American Heart Association guidelines recommend a door-to-balloon time (DTB) <90 minutes for nontransferred patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention. Systems of care to achieve and sustain this DTB performance over several years have not been previously reported. Methods and Results-The Mayo Clinic STEMI protocol was implemented in April 2004 and included activation of the cardiac catheterization laboratory by the emergency medicine physician; a single call system to activate the catheterization laboratory; catheterization laboratory staff arrival within 20 to 30 minutes of activation; and real-time performance feedback within 24 to 48 hours. Data were collected on nontransferred STEMI patients. The preimplementation group (June 2002 to March 2004) comprised 96 patients with a median DTB of 97 (interquartile range, 82, 130) minutes, and 40% had a DTB <90 minutes. The postimplementation group (May 2004 to March 2008) comprised 322 patients with a median DTB of 67 (interquartile range, 55, 82) minutes, and 81% had a DTB <90 minutes. Postimplementation DTB was significantly shorter than preimplementation DTB (P<0.001). In the 4-year follow-up after protocol implementation, the DTB performance remained stable over time (P<0.41). Conclusions-The Mayo Clinic STEMI protocol implemented strategies to reduce DTB for nontransferred patients with STEMI. DTB was significantly reduced, and the results were sustained over the 4-year follow-up period. Our experience demonstrates the effectiveness and durability of process changes targeting timeliness of primary percutaneous coronary intervention. (Circ Cardiovasc Qual Outcomes. 2009;2:508-513.)

AB - Background-American College of Cardiology/American Heart Association guidelines recommend a door-to-balloon time (DTB) <90 minutes for nontransferred patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention. Systems of care to achieve and sustain this DTB performance over several years have not been previously reported. Methods and Results-The Mayo Clinic STEMI protocol was implemented in April 2004 and included activation of the cardiac catheterization laboratory by the emergency medicine physician; a single call system to activate the catheterization laboratory; catheterization laboratory staff arrival within 20 to 30 minutes of activation; and real-time performance feedback within 24 to 48 hours. Data were collected on nontransferred STEMI patients. The preimplementation group (June 2002 to March 2004) comprised 96 patients with a median DTB of 97 (interquartile range, 82, 130) minutes, and 40% had a DTB <90 minutes. The postimplementation group (May 2004 to March 2008) comprised 322 patients with a median DTB of 67 (interquartile range, 55, 82) minutes, and 81% had a DTB <90 minutes. Postimplementation DTB was significantly shorter than preimplementation DTB (P<0.001). In the 4-year follow-up after protocol implementation, the DTB performance remained stable over time (P<0.41). Conclusions-The Mayo Clinic STEMI protocol implemented strategies to reduce DTB for nontransferred patients with STEMI. DTB was significantly reduced, and the results were sustained over the 4-year follow-up period. Our experience demonstrates the effectiveness and durability of process changes targeting timeliness of primary percutaneous coronary intervention. (Circ Cardiovasc Qual Outcomes. 2009;2:508-513.)

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