News | Published February 7, 2012

Mount Nittany Medical Center Continues to Improve Door to Balloon Time and Patients Can Help

Door to balloon time (DTBT) is one of the principal reasons for NOT driving yourself to the hospital when experiencing chest pain, primarily because life-saving procedures or diagnostics can take place in the ambulance.

First responders in the ambulance can obtain vital information, such as the electrocardiogram results and patient history, which can then be transmitted to the hospital before arrival, allowing for activation of the heart alert team.

DTBT is the time it takes for a patient to arrive at the "door" of the emergency room until the doctors push a tube through an artery to the clot, inflate a tiny "balloon" to flatten it, and place a mesh prop called a stent to keep the artery open.

"Every minute with clogged arteries is a minute the heart is deprived of life-saving oxygen, which can lead to death or heart damage," according to James Gerardo, MD, PhD and interventional cardiologist at Mount Nittany Physician Group. "Even though we are within the recommended 90 minutes DTBT, we try to save every minute."

The majority of hospitals around the country have improved the DTBT over the last five years, according to a study published this summer by the American Heart Association journal, Circulation.

Dr. Harlan Krumholz, a Yale cardiologist who led the study, said the improvement occurred because of education about the ways to shorten treatment times.

Mount Nittany Medical Center is constantly doing quantitative analysis in order to streamline processes and improve DTBT according to Michal Schneider, registered cardiovascular-invasive specialist.

The goal is to get the patient into the catherization lab very quickly in order to begin the angioplasty, the term for the balloon procedure that unclogs the artery. Mount Nittany has instituted "heart alert boxes" which puts together all the instruments, equipment, and paperwork necessary to proceed to the cath lab in a timely fashion once the diagnosis is made.

Another time-saver is the 30 second distance from the emergency department trauma area to the cath lab at the Medical Center. A five minute interval for transport is considered standard according to The American College of Cardiology 's 90 minute recommendation for DTBT.

"At Mount Nittany, that 30 second distance from the ER really helps with our DTBT," said Schneider. In fact, in many cases, the DTBT time is from 60 to 70 minutes or less, she said.

Gail Miller, RN, MS, CPHQ, vice president for quality at Mount Nittany Medical Center sits on the Mount Nittany Data and Safety Monitoring Board that reviews heart alert cases. "Our percent of patients with a door to balloon time within 90 min. in 2011 is 96%. This compares very favorably with the state (89%) and the national (90%) rates that are currently posted on the Medicare website, Hospital Compare," she said.