Date of this Version

7-23-2024

Document Type

DNP Project

Abstract

Background: Acute myocardial infarction (AMI) is a severe medical emergency caused by the abrupt blockage of coronary arteries, resulting in insufficient blood supply and heart tissue damage (Vogel et al., 2019). Primary percutaneous coronary intervention (PCI), using a catheter with an inflatable balloon, aims to restore blood flow by reopening blocked arteries (Zurowska-Wolak et al., 2019). The door-to-balloon (D2B) indicates the time from an ST-elevation myocardial infarction (STEMI) patient's hospital arrival to balloon inflation or stent deployment is crucial for achieving better patient outcomes and reducing hospital stays (Zurowska-Wolak et al., 2019).

Purpose: This quality improvement project initiative sought to decrease door-to-balloon times to under 60 minutes for Emergency Department (ED) patients presenting with ST-elevation myocardial infarction (STEMI) in at least 85% of cases.

Methods: This quality improvement project was held in a tertiary medical center in Delray Beach, Florida, using “the STEMI tracking” form to collect data for patients seen in the Emergency Department (ED) and diagnosed with STEMI. The project compared baseline data collected in September, October, and November in the year 2023 to post-implementation data in April, May, and June in the year 2024. The intervention included to the existing protocol, including the addition of an ICU-RN to the team and use of a digital notification alert.

Results: For patients with STEMI, the times compared were ED admission-to time to EKG, time in ED, time in corridor, time in cath-lab, and overall door to balloon time. Although, no statistically significant differences were found when comparing 2023 to 2024 data, likely due to small sample size and high data variability, all of the study variables showed a decrease in time from cases in 2023 to cases in 2024. The overall D2B time was reduced from 81.5 minutes in 2023 to 74 minutes following addition of the intervention.

Conclusion: This QI project aimed to reduce D2B times for STEMI patients at Delray Medical Center using an ICU-RN on the on-call team and a digital platform for notifications. While no significant post-intervention improvement was found (small sample, high variability), a trend toward faster times emerged which is important for the institution to meet the national standards of D2B times of 60 minutes. Limitations included sample size, population homogeneity, and data entry challenges. The project highlights the importance of interprofessional collaboration and the value of communication tools to promote positive patient outcomes. Future studies with robust methods are needed for definitive assessment.

Download

Share

COinS