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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
Section of Cardiovascular Medicine, Department of Medicine
Department of Psychiatry
Section of Emergency Medicine, Department of Surgery
^|| Department of Medicine
^¶ 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.