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Cardiology Research and Practice
Volume 2012 (2012), Article ID 616940, 4 pages
Research Article

“Register and Roll”: A Novel Initiative to Improve First Door-to-Balloon Time in ST Elevation Myocardial Infarction

1Division of Cardiology, Providence Heart Institute, 16001 West Nine Mile Road, Southfield, MI 48075, USA
2Division of Internal Medicine, Providence Hospital, Southfield, MI 48075, USA
3Department of Patient Care Research, Providence Hospital, Southfield, MI 48075, USA

Received 28 May 2012; Accepted 6 September 2012

Academic Editor: Patrick J. Goldstein

Copyright © 2012 Sachin Kumar Amruthlal Jain et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. We examined the cause of transfer delay in patients with an acute ST-segment myocardial infarction (STEMI) from non percutaneous coronary intervention (PCI) capable to PCI capable hospitals. We then implemented a novel, simple, and reliable initiative to improve the transfer process. Background. Guidelines established by the ACC/AHA call for door-to-balloon times of ≤90 minutes for patients with STEMI. When hospital transfer is necessary, this is only met in 8.6% of cases. Methods. All patients presenting with STEMI to a non-PCI capable hospital from April 2006 to February 2009 were analyzed retrospectively. After identifying causes of transfer delay the “Register and Roll” initiative was developed. An analysis of effect was conducted from March 2009 to July 2011. Results. 144 patients were included, 74 pre-initiative and 70 post- initiative. Time to EMS activation was a major delay in patient transfer. After implementation, the EMS activation time has significantly decreased and time to reperfusion approaches recommended goal (Median 114 min versus 90 min, ), with 55% in <90 minutes. Conclusion. “Register and Roll” streamlines the triage process and improves hospital transfer times. This initiative is easily instituted and reliable in a community hospital setting where resources are limited.