Reducing the DTB time for heart attack patients means higher survival rates. The National Heart Centre SIngapore (NHCS) explains how they did it.
The National Heart Centre Singapore (NHCS), a member of the SingHealth group, has shaved off 21 minutes on average from the door to balloon (DTB) time – the period between when a patient arrives at the hospital’s emergency department and when he receives a life-saving balloon angioplasty or percutaneous coronary intervention.
Many hospitals are working to reduce the DTB time. The international standard set by the American College of Cardiology and the American Heart Association is a DTB time of 90 minutes or less.
The NHCS previous time of 86 minutes (with 65 per cent of patients receiving coronary intervention within 90 minutes) complied with these standards. However, a team of NHCS doctors and nurses wanted to better the time.
Nurse Clinician Ong Bee Geok, 55, from the review team, said: “Though our timing was within the ministry’s requirements, we thought we could reduce it further.”
How they did it
Between 2010 and 2011, they improved protocols and reduced the mean DTB time to 65 minutes. They also increased the proportion of patients receiving angioplasty within 90 minutes to 85 per cent. The fastest DTB time achieved during this period was 45 minutes.
The chief improvement that helps save time is simultaneously getting the Cardiac Catheterisation Laboratory and the patient ready for the procedure, while the on-call team rushes down. The team consists of a cardiologist, scrub nurse, circulation nurse, radiographer and medical technologist.
The in-patient nurse clinician on duty, when alerted, is charged with heading there immediately to get the lab and patient ready so, when the on-call team arrives, they can start the procedure straightaway.
Reduced DTB times improves survival rate of heart attack patients
Reduced DTB times can increase the survival rate of heart attack patients who come through the hospital’s emergency doors.
Every year, NHCS sees about 120 heart attack patients needing coronary intervention after office hours.
Studies show that clearing blocked coronary vessels early can salvage heart muscle and improve the survival rate.
In a heart attack, a blockage or clot in an artery cuts off oxygen supply to the heart, damaging its muscles. This can eventually lead to heart failure or a high risk of dying from complications, such as abnormal heart rhythms.
Ms Ong said patients are already benefiting from the timesaving. “Here, we say time is muscles. When treated earlier, there is less damage to patients’ muscles, so they recover faster with fewer complications. Their average length of stay has also been shortened from about five days to three or four days.”
The centre is still on the lookout for other ways to further improve its response time. “If there are other ways to reduce the time further, we will definitely do it,” said Ms Ong.