The Heartbeat team from the Cardiac Catheterisation Laboratory (L-R): SSN Cing Suan Lian, SNM Tina Teo, SN Alipoyo Leilani and SN Jocelyn Ives Tan Jian Jun, took to disposables to up Door-to-Balloon time.

​Door-to-Balloon (DTB) time measures the time taken from the point of patient’s arrival at the doors of the emergency department to the reperfusion of the affected vessel at the Cardiac Catheterisation Laboratory (Cath Lab).

The survival of a heart attack patient, for example, could be impacted by how fast doctors can determine where and how much of their vessels are blocked via a coronary angiogram and then performing an angioplasty (i.e. ballooning).

“We see an average of 107 patients per week, an increase of almost 20% from 2016. The rising demand for Cath procedures has taken a toll on the staff. We looked at our processes and realised we have to do something about it,” said Senior Nurse Manager, Tina Teo from the Cath Lab who formed team Heartbeat to streamline the Lab’s workflow.

Lengthy process increases DTB time

Each morning before the day’s procedures commence, a nurse has to unload and tally all the instruments received from the Theatre Sterile Supply Unit (TSSU) and Central Sterile Services Department (CSSD)*. Each sterile instrument set has to be manually scanned into the system before distributing to the respective procedure rooms.

nurse tallies stock
A nurse has to tally all instruments every morning.

“We had to open as many as 22 individually wrapped sterile items to prepare for one procedure. After the procedure, the scrub nurse has to count all the instruments, rinse off blood stains, spray on an enzymatic solution before packing everything in a plastic bag. These steps pose a risk of cross-contamination as well,” shared Senior Staff Nurse and co-leader, Cing Suan Lian.

The used instruments are then sent back to TSSU for sterilisation while the nurse orders new instruments for the following day’s use. As much as 2,672 man-hours are spent on unnecessary, non-value adding steps.

Disposables improves staff and patient safety

Taking a leaf from customised cutlery sets used in commercial airlines, the team found a supplier who could provide the sterile requisites in biodegradable, disposable plastic. The instruments could also be packed in a set for each procedural use.

high quality disposable procedure set
High quality disposable procedure set.

While this saves time and efforts in counting and scanning of items, SNM Teo stressed that it was important to assess the quality of the disposables, “Doctors and nurses had a trial on the disposable sterile procedure set and were happy with its quality. Less time is needed to prepare for the procedure and the disposables can simply be thrown away after use so there’s lesser risk of infection too.”

Doctors and nurses trial the disposable set before implementation
Doctors and nurses trial the disposable set before implementation.

“For patients, it means that they can receive treatment faster and at a cheaper rate due to savings from materials. The DTB time has stabilised at 58 minutes when it used to stretch up to 75 minutes,” shared the team.


The affordability and practicality of disposables have since had spin-offs in the form of disposable scrub suits for all Cath Lab staff, surgical gowns and drapes for use during procedures, trolley covers to prevent spillage and so on.

Moving on, the team is also looking into enhancing the current disposable set for coronary angiogram by adding two more consumables so that the nurse only needs to open one set for the entire procedure.