Halabi Salim, Elias Awny, Goldberg Michael, Hurani Hilal, Darawsha Husein, Shachar Sharon, Ashkenazi Miti
Department of Emergency Medicine, Carmel Medical Center, Haifa Israel.
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Isr Med Assoc J. 2018 Aug;20(8):476-479.
Door-to-balloon time (DTBT) ≤ 90 minutes has become an important quality indicator in the management of ST-elevation myocardial infarction (STEMI). We identified three specific problems in the course from arrival of STEMI patients at our emergency department to initiation of balloon inflation and determined an intervention comprised of specific administrative and professional steps. The focus of the intervention was on triage within the emergency department (ED) and on increasing the efficiency and accuracy of electrocardiography interpretation.
To examine whether our intervention reduced the proportion of patients with DTBT > 90 minutes.
We compared DTBT of patients admitted to the ED with STEMI during the year preceding and the year following implementation of the intervention.
Demographic and clinical characteristics at presentation to the ED were similar for patients admitted to the ED in the year preceding and the year following intervention. The year preceding intervention, DTBT was > 90 minutes for 19/78 patients (24%). The year after intervention, DTBT was > 90 minutes for 17/102 patients (17%). For both years, the median DTBT was 1 hour. Patients with DTBT > 90 minutes tended to be older and more often female. Diagnoses in the ED were similar between those with DTBT ≤ 90 minutes and > 90 minutes. In-hospital mortality was 17% (13/78) and 14% (14/102) for the respective time periods.
An intervention specifically designed to address problems identified at one medical center was shown to decrease the proportion of patients with DTBT > 90 minutes.
门球时间（DTBT）≤90分钟已成为ST段抬高型心肌梗死（STEMI）管理中的一项重要质量指标。我们在STEMI患者从抵达急诊科到开始球囊扩张的过程中发现了三个具体问题，并确定了一项由特定行政和专业步骤组成的干预措施。该干预措施的重点是急诊科（ED）内的分诊以及提高心电图解读的效率和准确性。
研究我们的干预措施是否降低了DTBT>90分钟患者的比例。
我们比较了干预措施实施前一年和实施后一年在ED就诊的STEMI患者的DTBT。
干预前一年和干预后一年在ED就诊的患者在就诊时的人口统计学和临床特征相似。干预前一年，78例患者中有19例（24%）的DTBT>90分钟。干预后一年，102例患者中有17例（17%）的DTBT>90分钟。这两年的DTBT中位数均为1小时。DTBT>90分钟的患者往往年龄较大且女性居多。DTBT≤90分钟和>90分钟的患者在ED的诊断相似。相应时间段内的住院死亡率分别为17%（13/78）和14%（14/102）。
一项专门针对某一医疗中心发现的问题设计的干预措施被证明可降低DTBT>90分钟患者的比例。
