Improvement Stories

“Time is Muscle:” Reducing Door to Balloon Time Can Save Lives of Heart Attack Patients

Why does door-to-balloon matter to high-quality heart attack care?

Every minute counts when a patient suffers a severe heart attack. Indeed, “time is muscle” as for every minute blood flow to the heart is blocked, heart muscle is being deprived of oxygen. A patient’s chances of survival depend on the hospital having well-coordinated and efficient processes that move patients from the ambulance, through the Emergency Department, and into the cardiac catheterization lab to have the blockage removed. Studies have established a national benchmark called “door-to-balloon” time (DTB), which measures how quickly a patient moves from the emergency room to the Catheterization Lab. The current goal for hospital DTB performance is considered to be 90 minutes or less.

How did the MGH reduce door to balloon time?

Reducing DTB requires the extensive coordination between ambulance personnel, the Emergency Department and Cardiac Catheterization Lab personnel. By establishing standard processes, patients can be moved quickly through each essential step of their care. The MGH team is making steady progress. Among the many solutions implemented include working with Boston EMS and private ambulance companies to have them call ahead when a potential heart attack patient is en route to the hospital.

Where are we now?

From the time the MGH began its initiative to enhance the door-to-balloon time in 2002, the median door-to-balloon time has fallen more than 50 percent. Recent results for the time period July 1, 2012 to June 30, 2013 show that ninety-five percent (95%) of MGH heart attack patients have a door-to-balloon time of less than 90 minutes. In the last half of 2013, this rate has risen to 100%. This reduction means more heart attack patients have the chance to survive.


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