Strategies TO reduce time delays in patients with AcuTe coronary heart disease treated with primary PCI-the STOP WATCH study: A multistage action research project

Abstract

Objective: To identify, evaluate and reduce system delay times in an ST-elevation myocardial infarction (STEMI) network by targeted reorganisation of logistics and personal feedback to staff on time delays. Design: Multistage action research project. Three study phases were used (exploration, tailored intervention and evaluation). Setting: Single centre study, Sweden. Patients: Consecutive patients (N=156) with prehospital STEMI onset treated with primary percutaneous coronary intervention (PCI). Interventions: Areas of delays were identified through participant observations and collaborative discussions. To increase the awareness of delay factors, continuous feedback on time delays was given. Elements of the logistics' reorganisation were (1) prioritised ECG recording by emergency medical services personnel, (2) central evaluation of ECG in all patients and (3) start of PCI procedure when two of three PCI team members were on site. Multiple key time measurements were made before (N=67) and after (N=89) the intervention. Main outcomes: Time difference (minutes) in system delay between the preintervention and postintervention phases. Results: Time from first medical contact (FMC) to a patent artery and time from FMC-to-catheter laboratory (cath-lab) arrival decreased by 6 and 12 min, respectively (ns). Time from FMC-to-ECG recording remained unchanged after the intervention. Time from ECG to decision for primary PCI was reduced by 6 min, p=0.004 and time from ECG-to-cath-lab arrival by 11 min, p=0.02. Total time from diagnosis to a patent artery decreased by 11 min (ns). Conclusions: Identification of time delays in an STEMI network with awareness of delay factors, reorganisation of logistics and continuous feedback can reduce system delay times significantly.