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Keywords

door-to-balloon time, myocardial ischemia, myocardial reperfusion, ST-segment elevation myocardial infarction

 

Authors

  1. Evers, Julianne M. DNP, APRN, AGACNP-BC
  2. York, Nancy L. PhD, RN, CNE
  3. Owens, Heather PhD, RN
  4. Hardin-Pierce, Melanie G. DNP, APRN, ACNP-BC

Abstract

Background: ST-segment elevation myocardial infarction (STEMI) requires prompt therapy. It is recommended for door-to-balloon (DTB) times to be less than 90 minutes. In the United States, some locations have difficulty meeting this goal.

 

Objective: The objective of this study was to determine whether implementation of a STEMI network decreased DTB times at a large, STEMI-receiving, metropolitan academic hospital in the southeastern United States. Furthermore, differences among presentation types, including walk-in, emergency medical services, and transfers, were explored.

 

Methods: A pre-post time series study of electronic medical record data was conducted to evaluate the efficacy of a STEMI network.

 

Results: The sample included 127 patients with a diagnosis of STEMI, collected during 3 periods (T1, T2, and T3). Patients were primarily White (78.0%) and male (67.7%), with a mean (SD) age of 58.9 (13.9) years. The 1-way analysis of variance revealed a significant difference in overall DTB times, F2 = 11.66, P < .001. Post hoc comparisons indicated longer mean DTB times for T1 compared with T3 (P < .001) and T2 (P < .001). When exploring presentation type, 1-way analysis of variance revealed a significant difference in mean DTB times in transfer patients between T1 and T2 (P < .001) and T1 to T3 (P < .001). No other statistical differences were noted; however, all DTB times with the exception of T2 for emergency medical services presentation decreased.

 

Conclusions: Implementation of a STEMI network was effective at decreasing overall DTB times with patients who presented to the hospital with a diagnosis of STEMI.