Abstract P115: First Door-to-Balloon Time: Improving Door-to-Balloon Times in Patients Transferred for Primary Percutaneous Intervention

Objective: We sought to identify the cause of delay in the first door-to-balloon times (1stD2B) in patients presenting with an acute ST-segment myocardial infarction (STEMI) requiring transfer to a PCI capable hospital with post hoc implementation of novel yet simple and reliable initiative “Register and Roll” to improve the overall D2B. Background: National guidelines established by the ACC/AHA call for door-to-balloon (D2B) times of ≤ 90 minutes for patients presenting with STEMI undergoing PCI to facilitate timely reperfusion and salvage of the ischemic myocardium. In patients presenting to non-PCI capable hospitals the timely reperfusion (D2B ≤ 90 min) is met in only 8.6% of patients. Methods: A retrospective analysis was performed from April 2006 to May 2009 in all STEMI patients transferred for primary PCI (PPCI) to Providence Hospital's Heart Institute from non-PCI capable hospitals. Patient charts and available electronic records were reviewed. Patients under 18 years of age and those with indeterminate initial electrocardiogram were excluded. The” Register and Roll Initiative” designed to facilitate transfer to our PCI center was implemented in all transfer patients starting in June 2009 to December 2010. Results: A total of 148 patients were transferred for PPCI with 47 patients included post “Register and Roll”. Three local hospitals were involved in transferring of patients. The time to ECG, time to EMS activation, door-in-door-out, EMS transport time, and the first-door-to-balloon time were compared pre and post implementation. The door in-door out time played a major role in prolonging the time to reperfusion and after implantation; the patients were transferred sooner for PPCI resulting in improved 1stD2B. (140 min vs. 100 min, P < 0.05) Conclusion: Our novel initiative, “Register and Roll”, to facilitate prompt transfer of STEMI patients for primary PCI involves simple guideline, a CATH KIT and EMS notification, which improved delays in door-in-door-out time. This initiative is simple and reliable to follow in a community hospital setting, where resources are limited. AHA's “Lifeline Mission” recommends every health system to implement their own methods to facilitate the transfer and achieve the goal.