Project Title

Improving Door-to-Balloon Times in Adult Patients with ST-Elevation Myocardial Infarction by Utilizing a STEMI-RN

Author

Amanda HunterFollow

Date of Award

Summer 2023

Document Type

Final DNP Paper

Degree Name

Doctor of Nursing Practice (DNP) in Family Nurse Practitioner

Department

Nursing

Faculty Chair

Jessica Lockhart

Abstract

Background: Heart disease is the leading cause of death in Alabama. The national estimated annual incidence of myocardial infarction (MI) is 605,000 new and 200,000 recurrent attacks, of which approximately 170,000 are silent (Tsao et al., 2022). Roughly every 40 seconds, an American will have an MI (Tsao et al., 2022). An ST-elevation myocardial infarction (STEMI) occurs when one or more of the coronary arteries supplying the heart with blood occlude, leading to myocardial injury (Akbar et al., 2021). Clinical practice guidelines for STEMI recommend Door to Balloon (D2B) intervention in 90 minutes or less (O'Gara et al., 2013), while the European Society of Cardiology STEMI guidelines recommend reperfusion occur within 60 minutes (Ibanez et al., 2017). Early reperfusion is associated with favorable outcomes, including improved morbidity and mortality (Tsao et al., 2022).

Purpose: The Doctor of Nursing Practice (DNP) quality improvement project aims to decrease D2B times to within 60 minutes for patients arriving at the emergency department (ED) with STEMI. The project's goal is to meet the target timeframe at least 90% of the time.

Methods: This single-center quality improvement project was held at a regional hospital in Northeast Alabama, utilizing concurrent secondary data from all STEMI patients who underwent percutaneous coronary intervention (PCI). The project compared baseline data (12 weeks during the same implementation period in the previous year) to post-implementation data (12 weeks after implementation). Variables analyzed include door-to-electrocardiogram (ECG) time, door-to-activation of STEMI code, activation-to-arrival in the catheterization laboratory (cath lab), door-to-balloon (D2B) time, location of the lesion, and intervention received.

Results: After implementing a STEMI-RN, 60% of cases met the D2B goal of fewer than 60 minutes. In the previous year, 33% of patients met the target of 60 minutes or less. Sample sizes were too small to show statistical significance in the baseline and post-implementation groups. The metric presenting improvement opportunity includes the activation-to-arrival in the cath lab time. More research is needed to determine the cause of the delay.

Conclusion: Further study is needed to directly correlate the effect of a STEMI-RN on D2B times.

Recommended Citation

Hunter, Amanda, "Improving Door-to-Balloon Times in Adult Patients with ST-Elevation Myocardial Infarction by Utilizing a STEMI-RN" (2023). Doctor of Nursing Practice Projects. 100.
https://digitalcommons.jsu.edu/etds_nursing/100