Real-Time Intervention to Achieve Sustained Compliance in Door-to-Balloon Time for

The overall average D2B time for 2024 was 115.5 minutes, which is above the recommended benchmark of 90 minutes.

The overall average D2B time for Jan-25-May-25 was 105 minutes, exceeding the recommended benchmark of 90 minutes.

Determine the proportion of STEMI cases with D2B time exceeding 90 minutes at baseline (Apr–Jun 2025)

Calculate and trend average D2B time across 14 months (Apr 2025 – May 2026)

Conduct structured Root Cause Analysis (RCA) for all cases with D2B time >90 minutes

Design and implement real-time, cross-functional process interventions targeting identified delay drivers

Establish a sustainability framework to protect gains through continuous monitoring and escalation protocols

Attender counselling by senior ER & Cardiology consultants

Faster Admissions: Admission Desk must honor credit letters to avoid financial delays

Unplanned Pathway: Genuine medical pathway changes are excluded as delay reasons.

Bedside Troponin: Point-of-care Troponin machine removes lab waiting time and to reduce the TAT.

No ‘N/A’: ED must record clear reasons for all delays — ‘N/A’ is no longer accepted.

Staff Roster: Dedicated nurse and technician rosters ensure immediate availability.

Real-time monitoring of all STEMI pathways

Daily data validation and pathway compliance checks.

Fortnightly case review meetings were conducted involving the Emergency Department, Cardiology Department, and Cath Lab teams to analyze Door-to-Balloon (D2B) performance and identify opportunities for improvement.

Real-time data capture and daily validation of key STEMI time points were implemented to ensure data accuracy and facilitate timely corrective actions.

Fortnightly analysis of all STEMI cases was carried out with key stakeholders, including the Emergency Department team, Cath Lab team, and Billing team, to identify delays and address process gaps.

Continuous staff sensitization and training programs were conducted to reinforce the importance of timely STEMI management and adherence to D2B timelines.

Coordination with insurance providers and TPAs was strengthened to expedite financial clea

The implemented interventions resulted in a substantial and sustained reduction in Door-to-Balloon (D2B) time. Consistent achievement of the benchmark across all 11 months demonstrates effective process standardization and multidisciplinary coordination.

Regular case reviews, real-time data validation, stakeholder engagement, staff training, and insurer coordination contributed to the sustained improvement.

The best performance of 61.81 minutes reflects enhanced efficiency in STEMI identification, Cath Lab activation, patient transfer, and treatment initiation.

Delays in early recognition and activation of the STEMI pathway, particularly during peak emergency department workload.

Time taken to obtain patient and family consent for primary PCI.

Delays in financial clearance and insurance/TPA authorization prior to the procedure.

Variability in Cath Lab team mobilization during off-hours, weekends, and holidays.

Delays in patient transfer from the Emergency Department to the Cath Lab due to coordination or logistical issues.

Incomplete or delayed documentation of STEMI time points, affecting timely performance monitoring.

Occasional delays in ECG acquisition, interpretation, or cardiology consultation.

Communication gaps among the Emergency Department, Cardiology, Cath Lab, Billing, and ancillary support teams.

Patient-related factors, such as atypical presentation, late arrival after symptom onset, or clinical instability requiring stabilization before PCI.

Resource constraints, including Cath Lab availability during concurrent emergency procedures.

Early STEMI recognition and rapid activation of the Cath Lab are critical to achieving Door-to-Balloon (D2B) targets.

Regular multidisciplinary case reviews help identify recurring delays and support continuous process improvement.

Real-time data monitoring and validation improve the accuracy of performance tracking and enable timely interventions.

Standardized STEMI protocols and clear escalation pathways reduce treatment delays and improve coordination.

Continuous staff training and awareness reinforce adherence to evidence-based STEMI management timelines.