A hospital-wide system to ensure rapid treatment time across the entire spectrum of emergency percutaneous intervention

Objectives This study's aim was to describe a hospital‐wide system to deliver rapid door‐to‐balloon time across the entire spectrum of emergency percutaneous intervention. Background Many patients needing emergency PCI are excluded from door‐to‐balloon public reporting metric; these groups do not achieve door‐to‐balloon times ≤90 min and have increased mortality rates. Methods: We prospectively implemented a protocol for patients with STEMI or other emergency indication for catheterization mandating (1) emergency department physician or cardiologist activation of the catheterization lab and (2) immediate patient transfer to an immediately available catheterization lab by an in‐house nursing transfer team. Results From September 1, 2005 to December 31, 2008, 526 consecutive patients underwent emergency PCI. Median door‐to‐balloon time was 68 min with 85.7% ≤90 min overall. Important subgroups included primary emergency department (62.5 min), cardiorespiratory arrest (71 min), cardiogenic shock (68 min), need for temporary pacemaker or balloon pump (67 min), initial ECG without ST‐elevation (66.5 min), transfer from another ED (84 min), in‐hospital (70 min), and activation indications other than STEMI (68 min). Patients presenting to primary ED and in transfer were compared to historical controls. Treatment ≤90 min increased (28%–85%, P