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Door-to-Balloon Time Reduction: Quality Collaborative

Nowadays, many ways could be offered to improve the health of certain groups of people and offer initiatives for particular hospitals regarding the needs and expectations of their patients and staff. A successful quality collaborative is a goal several medical centers strive for. Such organizations work to create special conditions for treating patients, facilitate cooperation between hospitals and different health care providers, support the required portion of practices, share knowledge, and improve management. Besides, quality collaboratives have limited timescales to improve evidence-based practice and bring teams together (Howe & Bell, 2014). In this paper, a quality collaborative to reduce the door-to-balloon (D2B) time in STEMI patients at Kendall Regional Medical Center will be discussed.

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Quality Collaborative Identification

Kendall Regional Medical Center is a full-service emergency care organization that provides pediatrics and burn care for the citizens of Miami. Several patients visit the place every day to find out the required portion of help, explanations, and suggestions on how to improve their health. There are also many emerging cases when the medical staff has to work and decide quickly and effectively. A quality collaborative at Kendall Regional Medical Center is the organization that weights all strong and weak aspects of the medical center and offers suggestions that could help medical workers to improve the quality of their work and patients to be provided with guarantees and support.

Quality Collaborative Details


STEMI that stands for ST-Elevation Myocardial Infarction is the type of heart attack when patients suffer from the block in heart’s major arteries the goal of which is to supply oxygen and other important nutrients to the heart. For a long period, the problem of the D2B time bothered the employees of Kendall Regional Medical Center. It took about 60 minutes to help a STEMI patient, who arrives in the emergency department and needs a catheter being inserted. The investigations of the American Heart Association show that the D2B time should not exceed 90 minutes (Wilson et al., 2014). However, earlier interventions could lead to better patient outcomes (Ellahham, Aljabbari, Mananghaya, Raji, & Zubai, 2015). Therefore, the main purpose of the Kendall Regional Medical Center quality collaborative is to investigate national and state averages and clarify the measures to reduce the D2B time in STEMI patients.

Measures and Tools

The introduction of the quality collaborative should include a clear explanation of quality measures that include several tools with the help of which the quality of healthcare processes and their outcomes on patients and employees. The types of quality measures depend on the methods that are used to gather enough information on an issue. For example, it is possible to use patient-reported outcome measures based on questionnaires offered to patients (Frosch, 2015). The description of how patients perceive their health and the outcomes of the interventions used to improve their health. Besides, structure measures could be offered as the possibility to evaluate the existing infrastructure of health care settings and the ways health care is delivered to people including staff education and training, available facilities, and the policy environment.

Quality Improvement Measures

Many ways could be offered to reduce the D2B time, and each organization tries to use the one that is appropriate and less expensive. For example, Lean Six Sigma methods could be used to reduce D2B times. This method includes improvements in cardiac catheterization team activation, care flow, communication, and data gathering (Ellahham et al., 2015). Coyne et al. (2015) offer to reduce D2B times due to the reduction of door-to-ECG time for walk-in STEMI patients. Finally, STOP STEMI application was offered in 2014 as an opportunity to enhance the coordination and the level of communication between the medical workers, who could improve the quality of care offered to patients with STEMI (Dickson, Nedelcut, Seupaul, & Hamzeh, 2014). All these approaches could be used to reduce the time and improve the quality of care that is obligatory to STEMI patients.

Time is critical for millions of people, who suffer from heart infarctions. Besides, there is a saying that time saves muscle. The time when an intervention is performed by a hospital worker should be as short as possible. Therefore, such improvement measures as cross-training staff should be developed in Kendall Regional Medical Center to make sure that cath labs are always available and could be used by the representative of the emergency department even if a cardiologist or other appropriate worker is absent at the moment.

General Data Description

The success of a quality collaborative that aims at reducing the D2B time depends on how well the field is investigated and how effective each method and approach are explained. There are several quality issues Kendall Regional Medical Center faces with some of them properly addressed, and some of them needed more explanations and elaboration. First, it is necessary to gather the statistical data and prove that the improvements and reduction in D2B times could also reduce mortality rates. Menees et al. (2013) investigated that field of nursing and explained that the joint clinical practice guidelines developed by the American College of Cardiology and the American Heart Association supported the idea that 90 minutes or less could be enough for patients to be provided with the required portion of help as soon as they addressed to the emergency department.

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However, the reduction of mortality is a good reason for changes. Nowadays, only 80% of patients meet the goal that is established by the association (Menees et al., 2013). STEMI teams have to be properly coordinated and motivated. As soon as they comprehend their opportunities and their roles in the lives of their patients, the results of their work could be considerably improved. They start paying attention to the management details and organize their work in regards to the needs of their patients and the necessity to reduce the D2B time as soon as a STEMI patient is identified. It does not matter if a patient arrives at the center on their own or delivered by EMS personnel, the medical center’s workers have to take some steps to minimize the time of care provision.

Comparison of Scores to State and National Averages

Such states as Florida rely on the already offered regulations and rules introduced by the American College of Cardiology and the American Heart Association and consider the importance of such steps as data registry and data access. Still, the reports of Indiana hospitals and medical centers show that many organizations lack these regulations and need significant corrections. STEMI care is unique indeed. Time cannot be ignored or spent in vain. It is not enough for medical workers to understand their importance for patients. It is more important to be ready to take the steps, study new techniques, and offer new approaches with the help of which high-quality care delivery could be organized in a short period. Every change should be evaluated and understood by medical workers. Change management plays a crucial role in the quality collaborative development because it includes the possibility to train people, explain the tasks, and allocate the resources in the ways that are appropriate in the chosen medical center.


In general, the analysis of the steps taken by the American College of Cardiology and the American Heart Association and the conditions under which the workers of Kendall Regional Medical Center shows that the reduction of the D2B time in STEMI patients is possible by a variety of means. The achievements of other states and the explanations of past research are used to prove that certain attempts have been already made. The majority of them turned out to be successful indeed because they helped to reduce mortality rates and improve the quality of care offered to STEMI patients.

The main similarity of Kendall Regional Medical Center and other organizations from different states is the attention to the rules set by the Association. Though some improvements or additions are possible in medical centers, the conclusion remains to the same: organizations can reduce the D2B time to 90 minutes or less. However, no evidence of a reduction of this time up to 45 minutes could be found. Kendall Regional Medical Center could be the first organization that may combine such techniques as staff training, STOP STEMI application, and change management to reduce the time frames considerably.


Coyne, C.J., Testa, N., Desai, S., Lagrone, J., Chang, R., Zheng, L., & Kim, H. (2015). Improving door-to-balloon time by decreasing door-to-ECG time for walk-in STEMI patients. Western Journal of Emergency Medicine, 16(1), 184-189.

Dickson, R., Nedelcut, A., Seupaul, R., & Hamzeh, M. (2014). STOP STEMI© – A novel medical application to improve the coordination of STEMI care: A brief report on door-to-balloon times after initiating the application. Critical Pathways in Cardiology, 13(3), 85-88.

Ellahham, S., Aljabbari, S., Mananghaya, H., Raji, J., & Zubai, A. (2015). Reducing door-to-balloon time for acute ST elevation myocardial infarction in primary percutaneous intervention: Transformation using robust performance improvement. BMJ Quality Improvement Reports, 8(4), 1-4.

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Frosch, D.L. (2015). Patient-reported outcomes as a measure of healthcare quality. Journal of General Internal Medicine, 30(10), 1383-1384.

Howe, C. & Bell, D. (2014). Improving engagement in a quality collaborative. British Journal of Healthcare Management, 20(11), 528-535.

Menees, D., Peterson, E., Wang, Y., Curtis, J., Messenger, J., Rumsfeld, J.,… Burm, H. (2014). Door-to-balloon time and mortality among patients undergoing primary PCI. Survey of Anesthesiology, 58(4), 162-163.

Wilson, B. H., Humphrey, A. D., Cedarholm, J. C., Downey, W. E., Haber, R. H., Kowalchuk, G. J., Garvey, L. (2013). Achieving sustainable first door-to-balloon times of 90 minutes for regional transfer ST-segment elevation myocardial infarction. Journal of American Cardiovascular Interventions, 6(10), 1064-1071.

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