Achieving door-to-balloon times in less than 90 minutes. Development of a flow chart.

The use of percutaneous coronary intervention (PCI) for patients presenting with an ST-segment elevation myocardial infarction (STEMI) in less than 90 minutes has shown to significantly reduce mortality and morbidity. In 2006, the American College of Cardiology launched a national door-to-balloon initiative to "take the extraordinary performance of a few hospitals and make it the ordinary performance of every hospital." The purpose of this article is to present an advanced practice nurse's attempt to change practice and the challenges faced when attempted to improve upon a system. A flow chart was created and piloted to illustrate the appropriate steps needed to take to get a patient with a STEMI who walks into the emergency department (ED) to the cardiac catheterization laboratory. Implementation barriers were identified: (1) "going too fast"--not waiting for findings of serum creatinine levels and sending patients into kidney failure secondary to the contrast dye that is used during PCI; and (2) hesitation by certain cardiologists to allow ED physicians to initiate the cardiac catheterization laboratory. Although evidence is clear that change is necessary and that some of the barriers have easy solutions (eg, the use of an interdisciplinary team), some barriers are harder to tackle and need continued education.