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Door-to-Balloon Times
Why Are They Important?
Introduction or Background
• The national standard for doorto-balloon time is 90 minutes, as
recommended by the American Heart
Association/American College of
Cardiology guidelines for ST-elevation
myocardial infarction (STEMI)
• Door-to-balloon time is defined as the
time lapse from when an ST elevated
MI enters the Emergency room till
the time when a catheter guidewire
crosses the culprit lesion in the Cardiac
Cath Lab
Ben Marziale RN, CCRN, Dawn Veech MSN, RN,
Operations Coordinator, Special Procedures / Cardiology
Ochsner Baptist Medical Center, New Orleans, Louisiana
Measuring Outcomes
• Many studies have been conducted
that show that changing a few practices
can greatly reduce door-to-balloon
times. Some of these studies were
specific to community based hospitals
• The importance of the door-to-balloon
time is highlighted by its inclusion
as one of the core quality measures
collected and reported by the Centers
for Medicare and Medicaid Services
(CMS) and the Joint Commission
on Accreditation of Healthcare
Organizations.
Literature Review
Level of
Findings
Evidence
Level 3
A 2005 – 2006 study of 43,801 with ST
elevation myocardial infarctions showed
a steady increase in mortality that correlated with an increased door-to-balloon
time. Patients whose door-to-balloon
times that were under 90 minutes had
an average mortality rate of 3.6%. Those
with door-to-balloon times of 90 – 180
minutes had an average mortality rate of
Level 3
7%. (Rathore et al)
A study released in February 2011 that
analyzed all door-to-balloon times reported to CMS form January 1, 2005
through September 30, 2010 showed a
significant decrease in times during that
span. Median time at the end of 2005
was 96 minutes. The median time was
reduced to 64 minutes in the first three
quarters of 2010. (Krumholz et al)
• Door-to-balloon times are measured in
minutes and the average for each month
recorded
• Door-to-balloon time measurement began in
December 2009 which reflected time did not
meet the national standard
Purpose
• Meet the AHA guideline of door-to-balloon time in
90 minutes or less for 100% of our patients
Project Description
• Establish and implement interventions to improve
door-to-balloon times
• A team of emergency room staff, Cath Lab staff
and administrative coordinators implemented the
following changes:
oOne number now pages all Cath Lab personnel
to alert them of a STEMI
oER physician can activate a STEMI
before the interventional cardiologist
assesses the patient
oER to have patient ready to go to
Cath Lab within 30 minutes
oSTEMI packet now in PYXIS with
set up medications for the procedure
table
oClinical administrators pull the STEMI
packets and start opening the drape
kit prior to cath team arrival
oER staff brings patient to the Cath
Lab as soon as one member of the
Cath Lab team arrives
Findings
• Door-to-balloon time from December 2009
through April 2010 averaged 108 minutes
• Following interventions to improve door-toballoon time were initiated, the time dropped
to 78 minutes for the 16-month period April
2010 through August 2011
• During the 16-month period only twice was
the 90-minute window not met and none have
occurred in 2011
Conclusion
• Implementations have been
effective in reducing our door-toballoon times to meet national
standards
Implications for Nursing
• Nursing’s role in reducing times
is related to early recognition of
possible ST elevated MI’s. These
patients can be in the Emergency
room, inpatient or outpatient
setting
• Quick activation of the hospitals
STEMI plan is critical to success
• Continuing to monitor doorto-balloon times fosters
improvement in outcomes
• Continued development of new
strategies to further reduce doorto-balloon times remain important
References
K r u m h o l z , H . M . e t a l . ( 2 0 11 ) .
Improvements in door-to-balloon
time in the United States, 2005
to 2010. Circulation, 124, 10381045.
M a h l e r, S . A . , e t . a l ( 2 0 1 0 ) .
Emergency department
activation of interventional
cardiology to reduce door-toballoon time. Western Journal of
Emergency Medicine, 9(4), 363366.
Rathore, S.S., et al. (2009). Association of door-to-balloon time
and mortality in patients admitted to hospital with st elevation
myocardial infarction: National
c o h o r t s t u d y. B r i t i s h M e d i c a l
J o u r n a l , M a y, d o i : 1 0 . 11 3 6 / b m j .
b1807.