Strategies for Improving Door-to-Needle Times of Patients with ST-Segment Elevation Myocardial Infarction (STEMI), our five years period experiences

Introduction: Primary PCI has emerged as an effective strategy for acute STEMI. Shortening the time to reperfusion is associated with better outcome . The Israeli minister of health established the door to needle time (D2N-T) up to 90 minutes as an indicator of quality in primary PCI and recruited hospitals to participate in this competition. Our cardinal aim was to shorten the D2N-T as lower as we could, using a number of new interventions. Methods: We analyzed annual trends in (D2N-T); interval from first hospital contact to arterial puncture for PCI . We used data from 422 consecutive patients undergoing primary PCI for STEMI from January 2016 through December 2020 at our hospitals. Strategies for shortening this time were: Educational sessions for junior doctors and cardiac nursing staff. Posters relating to STEMI criterions in ECG for early recognition and diagnosis in emergency department (ED) and other departments. Door-to-ECG time up to 10 min for every patient referring to ED with chest pain. Educational sessions for emergency medical services (EMS) personnel for direct transferring to our department (bypass the ED). Training on the use of a remote electronic ECG interpretation system for early calling the catheterization team. Finally, debriefing every case that failed to achieve the target time. Results: The number of patients for whom the D2N- time was 90 minutes or less had significantly increased through five years from 70% in 2016 to 99% in 2020 (P<0.001). The number of patients that referred directly by ambulance to our department or catheterization lab increased significantly from 43 (70%) in 2016 to 90 (87%) in 2020. Median D2N-T was shortened gradually from 54 m, 45 m, 51 m, 49 m and 42 m, over the years: 2016, 2017, 2018, 2019, 2020 respectively; (P<0.001). Conclusions: Among STEMI patients the time from symptoms to open artery is critical for the outcome. Our effort to shorten the D2N-T through five years using simple strategies was successful and effective.