Reducing the Door-to-Balloon Time for ST-Segment Elevation Myocardial Infarction: The Result of a Hospital Quality Improvement Initiative

縮短急性ST段上升型心肌梗塞到院至完成冠狀動脈氣球擴張時間：醫院品質改善方案的結果

范傑閔(Chieh-Min Fan) ； 賴超倫(Chao-Lun Lai) ； 李愛先(Ai-Hsien Li) ； 蔡光超(Kuang-Chau Tsai) ； 鍾國彪(Kuo-Piao Chung)

《Journal of Emergency Medicine, Taiwan》 12卷4期 (2010/12) Pp. 107-113

摘要

Background: A door-to-balloon (D2B) time of less than 90 minutes in patients with acute ST-segment elevation myocardial infarction (STEMI) has been established as the standard practice for primary percutaneous coronary intervention (PCI). An internal monitoring system showed poor performance in D2B times at our hospital.
Objectives: We conducted a before-and-after study to evaluate the effectiveness of a quality improvement initiative.
Methods: An audit program with a checklist was implemented between February 1(superscript st), 2007 and October 31(superscript st), 2007 as the control period to record the patients' characteristics and the treatment timelines of every primary PCI. Seven improvement strategies were implemented simultaneously after November 1st, 2007. Two sample Wilcoxon rank-sum tests were used to compare median D2B times between the two periods.
Results: In patients with acute STEMI who visited our hospital directly, the median D2B time decreased from 140 minutes to 87.5 minutes (p＜0.05). The proportion of D2B times less than 90 minutes increased from 14.6% to 57.0% (p＜0.05). In those who were transferred from other hospitals, the median D2B time decreased from 105 minutes to 73 minutes (p＜0.05), and the proportion of D2B times less than 90 minutes increased from 35.3% to 78.9% (p＜0.05). The major improvement was decreasing the total time patients stayed at the ER after a diagnosis of STEMI was made.
Conclusion: Our study demonstrated that a quality improvement initiative conducted by a multidisciplinary team did indeed improve the performance of D2B times and several interventions could be implemented effectively at the same time.

關鍵字

D2B時間 ； 品質改善 ； 團隊

並列摘要

Background: A door-to-balloon (D2B) time of less than 90 minutes in patients with acute ST-segment elevation myocardial infarction (STEMI) has been established as the standard practice for primary percutaneous coronary intervention (PCI). An internal monitoring system showed poor performance in D2B times at our hospital.
Objectives: We conducted a before-and-after study to evaluate the effectiveness of a quality improvement initiative.
Methods: An audit program with a checklist was implemented between February 1(superscript st), 2007 and October 31(superscript st), 2007 as the control period to record the patients' characteristics and the treatment timelines of every primary PCI. Seven improvement strategies were implemented simultaneously after November 1st, 2007. Two sample Wilcoxon rank-sum tests were used to compare median D2B times between the two periods.
Results: In patients with acute STEMI who visited our hospital directly, the median D2B time decreased from 140 minutes to 87.5 minutes (p＜0.05). The proportion of D2B times less than 90 minutes increased from 14.6% to 57.0% (p＜0.05). In those who were transferred from other hospitals, the median D2B time decreased from 105 minutes to 73 minutes (p＜0.05), and the proportion of D2B times less than 90 minutes increased from 35.3% to 78.9% (p＜0.05). The major improvement was decreasing the total time patients stayed at the ER after a diagnosis of STEMI was made.
Conclusion: Our study demonstrated that a quality improvement initiative conducted by a multidisciplinary team did indeed improve the performance of D2B times and several interventions could be implemented effectively at the same time.

並列關鍵字

door-to-Balloon time ； quality improvement ； team ； myocardial infarction ； percutaneous coronary intervention