Effectiveness of a Myocardial Infarction Protocol in Reducing Door-to-Ballon Time

Background

An adequate door-to-balloon time (<120 minutes) is the necessary condition forthe efficacy of primary angioplasty in infarction to translate into effectiveness.

Objective

To describe the effectiveness of a quality of care protocol in reducing thedoor-to-balloon time.

Methods

Between May 2010 and August 2012, all individuals undergoing primary angioplastyin our hospital were analyzed. The door time was electronically recorded at themoment the patient took a number to be evaluated in the emergency room, whichoccurred prior to filling the check-in forms and to the triage. The balloon timewas defined as the beginning of artery opening (introduction of the first device).The first 5 months of monitoring corresponded to the period of pre-implementationof the protocol. The protocol comprised the definition of a flowchart of actionsfrom patient arrival at the hospital, the team''s awareness raising in relation tothe prioritization of time, and provision of a periodic feedback on the resultsand possible inadequacies.

Results

A total of 50 individuals were assessed. They were divided into five groups of 10sequential patients (one group pre-and four groups post-protocol). Thedoor-to-balloon time regarding the 10 cases recorded before protocolimplementation was 200 ± 77 minutes. After protocol implementation, there was aprogressive reduction of the door-to-balloon time to 142 ± 78 minutes in the first10 patients, then to 150 ± 50 minutes, 131 ± 37 minutes and, finally, 116 ± 29minutes in the three sequential groups of 10 patients, respectively. Linearregression between sequential patients and the door-to-balloon time (r = - 0.41)showed a regression coefficient of - 1.74 minutes.

Conclusion

The protocol implementation proved effective in the reduction of thedoor-to-balloon time.