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Achieving Door-to-Balloon Times That Meet Quality Guidelines

How Do Successful Hospitals Do It?

Elizabeth H. Bradley, PhD^_*, Sarah A. Roumanis, RN^#, Martha J. Radford, MD, FACC^,#, Tashonna R. Webster, MPH^_*, Robert L. McNamara, MD, MHS, Jennifer A. Mattera, MPH^#, Barbara A. Barton, RN^#, David N. Berg, PhD, Edward L. Portnay, MD, Harry Moscovitz, MD, Janet Parkosewich, RN, MSN^_**, Eric S. Holmboe, MD^||, Martha Blaney, PharmD and Harlan M. Krumholz, MD, SM, FACC^_*,,¶,#,_*

^_* Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
Section of Emergency Medicine, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
^|| Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
^¶ Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut
^# Yale New Haven Health Center for Outcomes Research and Evaluation, New Haven, Connecticut
^_** Yale New Haven Hospital and Yale University School of Nursing, New Haven, Connecticut
Genentech Inc., South San Francisco, California

View larger version (25K): [in a new window]   Figure 1 Flow chart for expediting acute reperfusion for patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention. *If no response within 10 min, go to the next one on the on-call list. CCU = coronary care unit; ECG = electrocardiogram; ED = emergency department; EMS = emergency medical service; IV = intravenous; PCI = percutaneous coronary intervention; Pt = patient.

View larger version (19K): [in a new window]   Figure 2 Path #1: steps and timeline for acute reperfusion: patients with pre-hospital electrocardiograms. MI = myocardial infarction; other abbreviations as in Figure 1.

View larger version (25K): [in a new window]   Figure 3 Path #2: steps and timeline for acute reperfusion: patients who arrive in the emergency department without pre-hospital electrocardiograms. Abbreviations as in Figures 1 and 2.