Elsevier

Progress in Cardiovascular Diseases

Volume 53, Issue 3, November–December 2010, Pages 219-226
Progress in Cardiovascular Diseases

Six Sigma Process Utilization in Reducing Door-to-Balloon Time at a Single Academic Tertiary Care Center

https://doi.org/10.1016/j.pcad.2010.08.002Get rights and content

Abstract

Background

Rapid reperfusion in patients with ST-elevation myocardial infarction (STEMI) is associated with lower mortality. Reduction in door-to-balloon (D2B) time for percutaneous coronary intervention requires multidisciplinary cooperation, process analysis, and quality improvement methodology.

Methods

Six Sigma methodology was used to reduce D2B times in STEMI patients presenting to a tertiary care center. Specific steps in STEMI care were determined, time goals were established, and processes were changed to reduce each step's duration. Outcomes were tracked, and timely feedback was given to providers.

Results

After process analysis and implementation of improvements, mean D2B times decreased from 128 to 90 minutes. Improvement has been sustained; as of June 2010, the mean D2B was 56 minutes, with 100% of patients meeting the 90-minute window for the year.

Conclusion

Six Sigma methodology and immediate provider feedback result in significant reductions in D2B times. The lessons learned may be extrapolated to other primary percutaneous coronary intervention centers.

Section snippets

Six Sigma methodology in D2B times

In April 2004, our institution, Wake Forest University Baptist Medical Center (WFUBMC), determined that a reduction in D2B times for our STEMI patients was a quality assurance priority. Six Sigma methodology was applied with full administrative support provided by the hospital administrative leadership and chief executive officer. The Six Sigma leader was the cardiac catheterization laboratory (CCL) director, but membership of the Six Sigma Task Force was truly multidisciplinary, with

Results

Individual data were available for 457 patient encounters from June 2002 through June 2009. Before implementation of the Six Sigma process, mean (SD) D2B time at WFUBMC was 128 (41) minutes, and 83% of patients did not meet the 90-minute D2B goal (Fig 5). During the 6 months of initial Six Sigma data definition and analysis (July 1–December 31, 2004), D2B times decreased to a mean (SD) of 99 (33) minutes. After initiation of the project, mean (SD) D2B time decreased during the pilot phase to 90

Discussion

The research evidence related to hospital strategies that are effective in reducing D2B time is limited and mostly has been generated from large observational studies, but in practice, these studies are pertinent for understanding effective and practical interventions for hospitals attempting to reduce D2B times. We have implemented processes recommended by several of these evidence-based studies and also have generated our own strategies that have helped produced continued D2B reductions at

Conclusion

Six Sigma methodology and real-time quality assurance feedback has resulted in significant reductions in D2B times in patients with STEMI at our tertiary care primary PCI institution. The lessons learned may be extrapolated to other primary PCI centers to improve the care of STEMI patients.

Statement of Conflict of Interest

All authors declare that there are no conflicts of interest.

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    Statement of Conflict of Interest: see page 225.

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