Optimizing Door-to-Balloon Time in STEMI Care through Structured Quality Improvement at a Tertiary Centre
Soumya Chandrasekhar, Satyajit Singh Gill, Radhika Wanjale, Sumati Dadkar, Priyanka Mahale, Sharmila Jayaram Mavudelli, Shrikanth MuralidharanAbstract
Background:
Door-to-balloon (DTB) time is a key performance metric in the management of ST-elevation myocardial infarction, with shorter times strongly associated with improved myocardial salvage and reduced mortality. International cardiology guidelines recommend achieving DTB within 90 minutes for patients undergoing primary percutaneous coronary intervention. This quality improvement (QI) initiative aimed to identify determinants of delayed DTB time in a tertiary care hospital and implement structured system-level interventions.
Methods:
Root-cause analysis revealed delays related to financial clearance processes, off-hour Cath lab staffing, concurrent laboratory use, and delayed arrival of consultants and anesthesiologists. Interventions included workflow standardization, staff duty rosters, night supervision protocols, and real-time communication channels linking emergency, cardiology, Cath lab, and administrative teams. Monthly DTB times were monitored from September 2022 to December 2025.
Results:
Median DTB times exceeded 100 min during the baseline period (101–111 min) but decreased to 69–84.6 min following implementation of the QI interventions. Achievement of the recommended DTB target (<90 min) became more consistent throughout the postintervention period.
Conclusion:
A structured multidisciplinary QI strategy focusing on financial workflow reform, staffing readiness, and real-time interdepartmental communication was associated with substantial and sustained reductions in DTB time at a tertiary care center. Continuous monitoring, protocol reinforcement, and adaptive process refinement were essential to maintaining performance near internationally recommended targets.