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| Format: | Artículo científico |
| Language: | en |
| Published: |
Sociedad Argentina de Cardiología
2017
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| Online Access: | https://www.redalyc.org/articulo.oa?id=305352117007 |
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Table of Contents:
- Optimization of Door-to-Balloon Time Implementing a Process Improvement Program GERARDO NAU NICOLÁS LALOR JUAN P. COSTABEL GUSTAVO PEDERNERA PABLO MORALES ALFONSINA CANDIELLO MARCELO TRIVI PABLO SPALETRA FERNANDO CURA MARIANO BENZADÓN Medicina to Time Treatment Angioplasty Myocardial Infarction Background: Primary percutaneous coronary intervention has played a major role in the treatment of ST-segment elevation acute myocardial infarction (STEMI). Delay in revascularization of the culprit vessel affects patient’s prognosis. Systematization within a medical institution with catheterization laboratory influences treatment delays. Objective: The aim of this study was to analyze the impact of a process improvement program on the door-to-balloon time of patients admitted with STEMI in a center with capability to perform primary percutaneous coronary intervention on a 24/7 basis. Methods: Patients with a diagnosis of STEMI requiring primary percutaneous coronary intervention were prospectively and consecutively included from January 2014 to May 2016. The population was divided into three periods: p1 control; p2 program implementation; p3 program operation. Patients with progressive STEMI, rescue angioplasty and Killip and Kimball D were excluded from the study. An analysis of the system was performed to detect the barriers by means of an improvement model. The process was redesigned incorporating the following strategies: ambulance preactivation for patient admission, bypassing the emergency department and catheterization laboratory activation. Results: Three hundred and fifteen patients were included in the study (p1: 125, p2: 99, p3: 91). There were no differences in baseline population characteristics between the periods analyzed. In 27.1% of cases patients consulted directly at the emergency room, 47.7% were admitted through the emergency service and 24.6% were referred from another center without capacity to perform primary percutaneous coronary intervention. During p3, pre-activation, bypassing the emergency department and possibility of a ready cath lab were implemented in 54.1%, 59.7% and 79.1% of patients, respectively. A significant reduction in door-to-balloon time was observed throughout the periods [p1 76 min (IQR 55-120), p2 53 min (IQR 30-89) and p3 46 min (IQR 29-59); P<0.01]. The trend was maintained both during working hours [p1: 76 min (IQR 53-125), p2: 36 min (IQR 26-60) and p3: 40.5 min (IQR 21-53.5); p1 vs. p3 p=0.02] as during the emergency shift [p1: 80.5 min (IQR 60.2-115), p2: 80 min (IQR 37-100) and p3: 54 min (IQR 34-62, 7); p1 vs. p3 p=0.01]. Impact was obtained in the first physician contact-balloon time [p1: 149 min (IQR 105-195) vs. p3: 94 min (IQR 73.5-130); p=0.012]. Conclusion: An improvement program allows a significant reduction of the door-to-balloon time in patients admitted with STEMI in a center with capability to perform primary percutaneous coronary intervention on a 24/7 basis. 2017 artículo científico 0034-7000 https://www.redalyc.org/articulo.oa?id=305352117007 en http://www.redalyc.org/revista.oa?id=3053 Revista Argentina de Cardiología application/pdf Sociedad Argentina de Cardiología Revista Argentina de Cardiología (Argentina) Num.2 Vol.85