Door-To-Balloon Time: Legal and Regulatory Requirements

Clinical Activity: Legal and Regulatory Requirements

When designing and selecting the most suitable evidence-based strategies to reduce door-to-balloon (D2B) time in ST-elevation myocardial infarction (STEMI) patients at Kendall Regional Medical Center in Miami, it is critical to pay attention not only to the actions and competencies of the nurses but also to legal and regulatory requirements. Today D2B time is one of the most crucial issues in medicine, as the associated mortality rates remain high (Biancardi, 2013). To understand how this process is controlled by the government, it is vital to assess the different requirements developed by the state of Florida, federal agencies, and accredited bodies as well as the reasons for introducing these controls. A combination of these factors will influence the development of reliable and effective programs to reduce D2B time.

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In the first place, the state of Florida is highly focused on reducing mortality rates among STEMI patients. To this end, state authorities highly rely on the ACA guidelines underlining the substantial importance of percutaneous coronary intervention (PCI) within 90 minutes (Strom, Sand, & Box, 2016; Brush, 2012). As a consequence of regulations proposed by the state, it was necessary to develop a universal Emergency Medical Services (EMS) system to ensure that patients with STEMI would be transported to the hospital directly (Green & Nallamothu, 2015). To ensure that hospitals comply with these regulations, the Florida Agency for Health Administration actively monitors the medical facilities (Green & Nallamothu, 2015; Pathak, Comins, Forsyth, & Strom, 2015). The reasons for introducing these regulations are clear as they not only attempt to reduce D2B time to 90 minutes and decrease associated mortality rates but also have a positive impact on the cost-efficiency of the hospital and help distribute the federal budget effectively.

At the same time, federal agencies such as the Agency for Health Care Administration are also interested in improving the safety and health of patients. As mentioned earlier, this entity aims to ensure that medical facilities in the state comply with the guidelines and regulations introduced by the ACA and state authorities (reporting system) (Strom et al., 2016). Its strategies focus on reducing transportation time and controlling budgeting and spending. As a consequence, it was necessary to introduce an effective EMS system to ensure that medical technicians and specialists have the necessary training and licenses to minimize mortality rates among STEMI patients (“Florida Health: Emergency medical services system”, 2016). The licensing of these professionals is necessary because it ensures 911 communication services and makes transportation available 24/7 for STEMI patients. Indeed, emergency physicians are now recognized by medical professionals who have to be licensed and are prohibited from medical practice without accreditation (Suter, 2012).

Alternatively, one cannot underestimate the role of the Joint Commission, which sets the rules and establishes comprehensive criteria that an organization has to meet to be qualified as a particular entity (“The Joint Commission: State recognition details”, 2017). As mentioned above, licensing and certification are forms of recognition that are often used to determine whether a hospital is eligible to perform particular procedures. For example, a stroke center under 59 FL ADC 59A-3.2085 is an entity developed in Florida to diagnose cardiovascular problems and prevent strokes (“The Joint Commission: State recognition details”, 2017). It could be said that these centers were designed as a consequence of the need to reduce mortality rates and ensure high-quality care delivered on time. Overall, it is clear that all of the regulations mentioned above are interdependent. Their central goal is to ensure the safety and rapid delivery of services to STEMI patients by means of improved telecommunication (24/7), equipment, and licensing systems and trained personnel. A combination of these factors will not only help reduce mortality rates and D2B time but will also optimize the financial performance of medical facilities in Florida and Kendall Regional Medical Center particularly.


Biancardi, M. (2013). Door-to-balloon time in primary percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction: An audit from the accident and emergency department of Mater Dei Hospital, Malta. Malta Medical Journal, 25(4), 1-8.

Brush, J. (2012). Improving ST-elevation-myocardial infarction care. Circulation: Cardiovascular Quality and Outcomes, 5(1), 420-422.

Florida Health: Emergency medical services system. (2016). Web.

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Green, J., & Nallamothu, B. (2015). Direct emergency medical services transport in STEMI: Breaking the bank for non-PCI capable hospitals. Open Heart, 2(1), 139.

Pathak, E., Comins, M., Forsyth, C., & Strom, J. (2015). Routine diversion of patients with STEMI to high-volume PCI centers: Modelling a financial impact on referral hospitals. Open Heart, 2(1), 42.

Strom, J., Sand, I., & Box, L. (2016). Optimizing care for ST-elevation myocardial infarction patients: Applications of system engineering. Journal of Geriatric Cardiology, 13(11), 883-887.

Suter, R. (2012). Emergency medicine in the United States: A systematic review. World Journal of Emergency Medicine, 3(1), 5-11.

The Joint Commission: State recognition details. (2017). Web.

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