National Audit of Angioplasty Procedures - HQIP

9Delays to treatmentIn the treatment of STEMI by PCI, anydelay in the performance of PCI isassociated with a worse outcome forthe patient. There are two importantprocedural measures:• The time the patient calls for helpto the time of PCI treatment (call toballoon time) measures the entireprocess of care.• The time a patient arrives at a PCIcentre to the time of PCI treatment(door to balloon time) which assesseshow quickly the PCI unit can respondto the emergency.There are two routes into a PCI centrefor emegency PCI:• The patient is brought directly tothe centre by ambulance.• The patient is transferred from ahospital not capable of performingPCI to the centre that performs thePCI. This is known as interhospitaltransfer (IHT).The transfer process engendersadditional delays as can be seen inthe overall summary data in figure 17.A strategy to try to avoid interhospitaltransfers results in quicker and thereforebetter treatment. Figure 18 shows itsaves approximately 50 minutes of delay.The units that have performed more than5 primary PCIs during 2010 and theircodes are shown in table 3.The percentage of cases treated withintarget times by each PCI centre arepresented in figures 19 and 20.1009080Call to balloon time < 150 min (%) Door to balloon time < 90 min (%)94.392.285.1 86.987.985.681.378.87060BETTER504045.14830201002008200920102009201020082009201020092010Direct Interhospital transfer Direct Interhospital transferFigure 17Average time delays to emergency treatment in patients admitted to PCI centres directlyversus transferred from another hospital to the PCI centre19