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Case Reports
. 2025 Nov 5;30(35):104882.
doi: 10.1016/j.jaccas.2025.104882. Epub 2025 Sep 9.

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

Hashim Zaidi  1 , Waleed Kayani  2 , Eric Power  3 , Hei Kit Chan  3 , Sini Eapen  4 , Benjamin Karfunkle  5
Affiliations
Case Reports

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

Hashim Zaidi et al. JACC Case Rep. .

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.

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Conflict of interest statement

Funding Support and Author Disclosure The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Simplified Process Map of the Autolaunch Transfer Protocol BIPAP = bilevel positive airway pressure; EMS = emergency medical services; GI = gastrointestinal; HFNC = high-flow nasal cannula; LBBB = left bundle branch block; PCI = percutaneous coronary intervention; RN = registered nurse; STEMI = ST-segment elevation myocardial infarction.
Figure 2
Figure 2
Box Plot of DIDO Times Stratified by Time Periods and Autolaunch Status DIDO = door-in-door-out.
Figure 3
Figure 3
Visual Summary of the Autolaunch Initiative AHA = American Heart Association; ECG = electrocardiogram; QI = quality improvement; STEMI = ST-segment elevation myocardial infarction.
See this image and copyright information in PMC

References

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