1. D2B: Door-to-Balloon Initiative Guidelines for Kaleida Health

2. D2B: What does this mean? D2B is a national initiative to address door-to- balloon times for patients with ST-segment elevation myocardial infarction. European and US guidelines of American College of Cardiologists recommend primary PCI within 90 minutes of arrival at hospital door.

3. D2B Evidence-Based Strategies Research shows the following to be best-practice in achieving the 90 minute goal time: 1.One call by ED physician activates the cath lab 2.Cath lab team is ready in 20-30 minutes from time of activation 3.Approach to D2B is a team-based coordination of personnel from ED through cath lab

4. Why D2B at Kaleida? Kaleida is recognized in the community as: A leader in Cardiac Care Having state-of-the-art programs, equipment, and personnel enabling us to provide high quality of care for patients having MIs Being a leader in providing sound evidence- based care that meets or exceeds National Standards

5. Benefits of D2B Opportunity for Kaleida to show ourselves to be leaders in a national quality improvement campaign D2B initiative will have a positive impact on patient outcomes by helping to decrease mortality in STEMI patients IT’S THE RIGHT THING TO DO for our patients

6. D2B Time Defined Time is defined as: Time from hospital arrival to the establishment of reperfusion by an interventional device Remember, our goal for D2B in Kaleida is 90 minutes or less for 75% of STEMI patients.

7. D2B Goal Kaleida’ goal is to achieve a door-to-balloon time of less than or equal to 90 minutes for 75% of patients requiring primary PCI (angio) that are admitted to a site with a cath lab with diagnosis of ST-segment elevation myocardial infarction (STEMI)

8. Steps required to accomplish D2B goal time of 90 minutes or less: Patient is placed in dedicated room in ED (ex. Code Room) ECG is done enroute, or within 5 minutes of arrival STEMI is confirmed Cardiologist makes decision to order intervention ED physician initiates e-page to Cath Team Cath team arrives within 30-45 minutes from time of page Patient is transported to Cath Lab as soon as team is set up Final check takes place Patient is cathed and PCI balloon is inflated TOTAL TIME DOOR TO BALLOON IS LESS THAN 90 MINUTES!

9. Data Collection Information Date Time of arrival in ED Time ECG done Time ECG read by ED physician Time Cardiologist notified/Dr. ________ Decision for intervention? Yes/No Time of E-page Time of response from cath lab Time leaving ED Time arriving in cath lab Time of balloon inflation Total time D2B (goal is less than 90 minutes total)

10. Data Collection Tool

11. How will this be accomplished at Kaleida? Success of D2B depends on YOU and A coordinated effort of all members of the team from ED through cath lab Accurate data collection through use of Data Collection Tool Timely reporting of outcome of intervention