Mark A. Greenberg, MD
E. Scott Monrad, MD, CM
David Esses, M.D.
Any delay in treating myocardial infarction can result in localized hypoxia, thereby increasing heart muscle damage. Door-to-balloon (D2B), a measurement of emergency cardiac care time, denotes the interval between the moment a patient enters the emergency department to the time that patient receives a balloon angioplasty. AHA/ACC guidelines recommend a D2B under 90 minutes, a time interval that has become a core quality measure for the Joint Commission (JC).
Under Montefiore’s new streamlined protocol, when a patient experiencing a STEMI (ST-segment elevation myocardial infarction, or heart attack) arrives, the emergency room activates a team from all pertinent disciplines. Each team member has a push-to-talk phone allowing for instant group communication at the touch of a button. The team's redundant-notification process includes Internet paging with text messages transmitted by beeper and phone. Pre-assembled "STEMI kits" that include all medications needed during the procedure are one of several tools incorporated to save critical minutes.
In cases where patients are transferred from Bronx and Westchesters hospitals that are not equipped to perform emergency catheterization, a single call to a hotline results in immediate dispatch of ambulances, notification of the team, and preparation of the cardiac catheterization lab in advance of the patient's arrival.
Since the initiative was launched, Montefiore’s door-to-balloon record has been highly successful. The proportion of patients receiving treatment within 90 minutes continues to exceed 90 percent, with blood vessels re-opened in less than 60 minutes in many cases. These figures include overnights and weekends, historically challenging times for hospitals to provide immediate access to these services.