Improving Door-In-Door-Out Times for STEMI Transfer Patients: Impact of a Protocolized Autolaunch Process

Abstract

Background: The timely transfer of patients with ST-segment elevation myocardial infarction (STEMI) to percutaneous coronary intervention-capable centers is critical for improving outcomes. Although the American Heart Association recommends a door-in-door-out (DIDO) time of ≤30 minutes, national compliance remains low.

Project rationale: At Harris Health, no patients with STEMI met this benchmark before 2022. We implemented a quality improvement (QI) initiative, including an "Autolaunch" process, to expedite STEMI transfers.

Project summary: During 2022-2023, we introduced QI initiatives, including the Autolaunch protocol, for patients with unequivocal STEMI. This process included rapid emergency medical services activation, direct catheterization laboratory transfer, and prearrival cardiologist notification. Data were analyzed to assess DIDO times. Before intervention, the median DIDO time was 81 minutes, with 0% of patients meeting the ≤30-minute goal. Postimplementation, the DIDO time decreased to 41 minutes, and compliance reached 39.5%. In Autolaunch cases (n = 35), the median DIDO time was 26 minutes, and the compliance was 74.3%.

Take-home messages: The STEMI Autolaunch process significantly improved DIDO times. This protocolized approach may serve as a model for optimizing STEMI transfer efficiency and improving patient outcomes.

Keywords: EMS; PCI; STEMI; door-in-door-out; transfer.