UPMC Memorial cuts after-hours door-to-balloon time with new workflow

York, Pa.-based UPMC Memorial saw a 37-minute, door-to-table time for an after-hours heart attack patient. The key to their success was incremental improvement.

“Improvement doesn’t happen in giant leaps,” Gregg Reis, MD, interventional cardiologist at UPMC, said in an episode of Becker’s “Cardiology + Heart Surgery” podcast. “It happens in small, steady steps. For example, reducing the average time to EKG from 10 to seven minutes, improving medication administration in the emergency department or ensuring patients receive the right medications at discharge to prevent readmission. That kind of incremental improvement, combined with strong teamwork, helps us continually optimize patient care.”

For ST-elevation myocardial infarction care, incremental improvement took a few forms. Such as ensuring an interventional cardiologist, cardiovascular technician and nurse on call 24/7 who is within 30 minutes of the hospital. 

The hospital also built an early alert system. When a patient is identified as a STEMI case by ED or EMS staff, the team is activated through multiple alert systems using cell phones and pagers.

“It may sound old-fashioned, but pagers are still helpful in areas where cell service can be unreliable,” Dr. Reis said. “Having multiple modes of communication ensures the alert reaches everyone.”

Once alerted, the team mobilizes. The patient is taken into the cath lab and the artery is opened as soon as possible. The goal is to beat the American College of Cardiology’s guideline for a 90-minute door-to-balloon time. During the day, this is easier to achieve, but after-hour STEMI cases often see longer time.

However, UMPC Memorial was able to get an after-hours STEMI patient from door-to-balloon in only 37 minutes.

“The key factor was that the patient called EMS,” Dr. Reis said. “The EMS team performed an on-site EKG and transmitted it to the emergency department team, which confirmed the STEMI and activated the alert from the field. That early alert gave the cardiology team time to arrive at the hospital and prepare before the patient arrived. We were essentially able to meet the ambulance at the door, move the patient through the emergency department quickly and get them directly onto the cath lab table. That preparation allowed us to achieve a 37-minute door-to-balloon time.”