Door to balloon time is an important cardiovascular process measure because it is both clinically meaningful and actionable. On a patient level, door-to-balloon time directly correlates with an amount of time the myocardium undergoes ischemic
Ischemia
Ischemia or ischaemia is a restriction in blood supply to tissues, causing a shortage of oxygen that is needed for cellular metabolism. Ischemia is generally caused by problems with blood vessels, with resultant damage to or dysfunction of tissue. It also means local anemia in a given part of a body sometimes resulting from constriction. Ischemia comprises not only insufficiency of oxygen, b…
What is door-to-balloon time?
Door to balloon time is an important cardiovascular process measure because it is both clinically meaningful and actionable. On a patient level, door-to-balloon time directly correlates with an amount of time the myocardium undergoes ischemic damage.
What is door to balloon time in ECC?
Door-to-balloon. Door-to-balloon is a time measurement in emergency cardiac care (ECC), specifically in the treatment of ST segment elevation myocardial infarction (or STEMI). The interval starts with the patient's arrival in the emergency department, and ends when a catheter guidewire crosses the culprit lesion in the cardiac cath lab.
Does door-to-balloon time improve health outcomes?
An emphasis on door-to-balloon time as a metric must be met with evidence that improvements in this metric lead to improvements in outcomes. While longer door-to-balloon time is associated with worse outcomes, 2-6 it is unclear whether improvements in door-to-balloon time as a metric can cause improved health outcomes.
What is door-to-balloon time for STEMI?
Door-to-balloon time is a phrase that denotes the time between the arrival of a patient with STEMI in the emergency room until the time that a balloon is inflated in the occluded, culprit coronary artery.
What is the goal door-to-balloon time?
On the basis of these data, current joint clinical practice guidelines of the American College of Cardiology and the American Heart Association (ACC–AHA) endorse a door-to-balloon time of 90 minutes or less as the goal, giving it a Class I (highest level) recommendation.
What is door-to-balloon time for STEMI?
Based on the association between shorter times to reperfusion and lower mortality in patients with ST-segment–elevation myocardial infarction (STEMI),1,2 consensus guidelines recommend a door-to-balloon (D2B) time of 90 minutes or less for STEMI patients undergoing primary percutaneous coronary intervention (PCI).
What does it mean when somebody says door-to-balloon time?
Door-to-balloon time is the time from when a heart attack patient arrives in the emergency room until percutaneous coronary intervention is performed to restore blood flow. Delayed treatment can worsen heart attack impact.
What is the goal for PCI?
Coronary artery disease (CAD) is one of the leading causes of death. Percutaneous coronary intervention (PCI) is a non-surgical, invasive procedure with the goal of relieving the narrowing or occlusion of the coronary artery and improve blood supply to the ischemic tissue.
How do you reduce door-to-balloon time?
5 Ways to Reduce Door to Balloon TimeTransmitting ECGs from the field to the hospital. ... Training EMS staff to read and interpret PH-ECGs. ... Cross-training staff to prepare the cath lab. ... Direct transfer to catherization. ... Immediate access to patient ECGs.
What is the goal for first medical contact balloon?
Accordingly, current guidelines recommend keeping the time between first medical contact (FMC) to inflation of balloon to less than 90 minutes [5, 6].
What is door in door out time?
Door-in to door-out (DIDO) time, defined as the duration of time from arrival to discharge at the first or STEMI referral hospital, is a new clinical performance measure, and a DIDO time of 30 minutes or less is recommended to expedite reperfusion care.
What is door to device time?
In emergency treatment of heart attacks, “door-to-device time” refers to the interval from when the patient is present in the emergency department to when their artery is opened in the cardiac catheterization lab.
What is door-to-needle time STEMI?
Depending on the available in-hospital facilities, the goal for patients with STEMI should be to achieve a door-to-needle time within 30 minutes (for thrombolysis) and a door-to-balloon time within 90 minutes (for PCI).
What are the advantages of performing PCI?
Primary percutaneous coronary intervention (P-PCI) significantly decreases mortality of patients presenting with ST elevation myocardial infarction (STEMI) and constitutes a type I A indication in the international clinical guidelines for the treatment of acute coronary syndrome (ACS).
What is your goal for PCI when treating patient?
In the setting of acute ST-elevation myocardial infarction (STEMI), the primary goal of percutaneous coronary intervention (PCI) or fibrinolysis is to reestablish patency of the affected coronary artery and thereby improve perfusion of the myocardium.
What is the time frame for PCI?
Introduction. The 2013 American College of Cardiology Foundation/American Heart Association guidelines for STEMI recommend that hospitals capable of primary PCI should treat patients within 90 minutes of contact with the medical system.
What is door to needle time mi?
Current guidelines for STEMI recommend a door-to-needle time within 30 minutes for fibrinolytic therapy and a door-to-balloon time within 90 minutes for primary PCI as treatment goals.
What is code STEMI protocol?
Code STEMI is a program designed to help medical professionals recognize heart attacks and immediately activate a protocol that ensures patients receive lifesaving care as quickly as possible. At NHRMC, we focus on reducing heart attack treatment times to give the best chance for a full recovery.
What is ballooning of the heart?
Coronary angioplasty is a medical procedure in which a balloon is used to open a blockage in a coronary (heart) artery narrowed by atherosclerosis. This procedure improves blood flow to the heart. Atherosclerosis is a condition in which a material called plaque builds up on the inner walls of the arteries.
What is the time frame to transfer a patient to a hospital capable of PCI?
Timely reperfusion strategy is recommended for the management of ST-segment-elevation myocardial infarction (STEMI) patients, and primary percutaneous coronary intervention (PCI) is the preferred reperfusion therapy when first-medical-contact-to-balloon time is within 90 minutes for patients admitted directly to a PCI- ...
The 90-Minute Goal
One of the most commonly tracked metrics relates to the arrival of an ST-Elevation Myocardial Infarction (STEMI) patient to the ED, to when he or she receives a Percutaneous Coronary Intervention (PCI) or a balloon angioplasty.
Getting More Specific
Interestingly, as time has passed since the first focus on door-to-balloon times, the metrics for hospitals and EMS agencies have evolved to be more specific.
Metrics Are Key to Care
STEMI and stroke are just two of the interventions where success relies heavily on time to treatment. However, correlations can be found for other treatment rates and overall performance metrics for hospitals. Benchmarks and metrics can also help reduce sentinel events by ensuring best practices are consistently followed in every procedure.
Better Data Exchange Along the Spectrum of Care
Hospitals today can take advantage of easy-to-use software tools designed to help share data with their EMS partners more easily and more securely. This data can be quickly and easily shared bidirectionally, analyzed, and reported out for a wide range of purposes.
Why is door to balloon time important?
Door to balloon time is an important cardiovascular process measure because it is both clinically meaningful and actionable. On a patient level, door-to-balloon time directly correlates with an amount of time the myocardium undergoes ischemic damage.
What is door to balloon time?
Door-to-balloon time is an integral process metric for measuring cardiovascular quality. Since its inclusion in the ACC/AHA Guidelines for STEMI management as a Class 1A recommendation, 1 door-to-balloon time has evolved into a national quality metric. CMS began publicly reporting this measure, and subsequently hospital performance on door-to-balloon time was tied to financial reimbursement. As a result, there has been considerable emphasis on improving hospital performance on this metric, which has changed not only the practice of cardiology, but also the coordination of health care delivery in acute care settings. However, as cardiovascular care has evolved, it becomes important to pause and consider whether door-to-balloon time as a metric in current practice has become misleading.
Is door to balloon time still publicly reported?
As such, door-to-balloon time will still be publicly reported, but it will no longer be a metric used to calculate financial payment. Given these changes in practice, it becomes important to critically re-evaluate the value of door-to-balloon time as a modern metric. Upon closer inspection, population-wide door-to- balloon time may not have improved ...
Is door to balloon time a metric?
Additionally, while door-to-balloon time is important, it represent s only a fraction of overall ische mic time, and emphasis on this metric should be made in concert with other efforts to improve cardiovascular care. Furthermore, the emphasis on improved door-to-balloon time as a metric can lead to unintended consequences if not considered ...
Is door to balloon time a risk factor?
In contrast to demographic and clinical characteristics known to affect patient outcomes, door-to-balloon time is a risk factor that is clearly modifiable by healthcare providers. Furthermore, there was considerable variation across institutions around the time of its adoption as a standardized quality metric, 7 allowing lower performing hospitals room for improvement and opportunities to learn from top performing hospitals. 8-10
Is door to balloon time a reflection of STEMI?
Nevertheless, door-to-balloon time, as currently reported to CMS is not a complete reflection of quality of STEMI care, and there may still be room for improvement. Further research is necessary to elucidate the true benefits of further improving door-to-balloon-time on patient outcomes in practice. Continued emphasis on improving performance on this metric must take into account both the potential benefits as well as unintended consequences of such actions for patient outcomes.
What is door to balloon?
Door-to-balloon is a time measurement in emergency cardiac care (ECC), specifically in the treatment of ST segment elevation myocardial infarction (or STEMI). The interval starts with the patient's arrival in the emergency department, and ends when a catheter guidewire crosses the culprit lesion in the cardiac cath lab. Because of the adage that "time is muscle", meaning that delays in treating a myocardial infarction increase the likelihood and amount of cardiac muscle damage due to localised hypoxia, ACC / AHA guidelines recommend a door-to-balloon interval of no more than 90 minutes. As of 2006 in the United States, fewer than half of STEMI patients received reperfusion with primary percutaneous coronary intervention within the guideline-recommended timeframe. It has become a core quality measure for the Joint Commission on Accreditation of Healthcare Organizations (TJC).
When did the door to balloon initiative start?
Few hospitals can provide PCI within the 90 minute interval, which prompted the American College of Cardiology (ACC) to launch a national Door to Balloon (D2B) Initiative in November 2006. The D2B Alliance seeks to "take the extraordinary performance of a few hospitals and make it the ordinary performance of every hospital.".