Impact of PDCA cycle optimization on door-to-wire time in patients with acute st-segment elevation myocardial infarction: a single-center retrospective before-and-after QI study.

BACKGROUND

Reducing door-to-wire (D-to-W) time is critical for improving care efficiency in patients with ST-segment elevation myocardial infarction (STEMI).

OBJECTIVES

This study evaluated the effect of a Plan-Do-Check-Act (PDCA) cycle-based quality improvement (QI) initiative on D-to-W time in a Chinese chest pain center.

METHODS

A single-center retrospective before-and-after QI study was conducted among 120 patients with STEMI undergoing primary percutaneous coronary intervention. The control group (n = 60) received standard care between June and July 2023, whereas the intervention group (n = 60) received PDCA-optimized care during the same seasonal period in 2024. The PDCA intervention included process mapping, root cause analysis, staff training, standardized communication, and a dedicated conductive paste applicator. The primary outcome was D-to-W time. Secondary outcomes included in-hospital clinical events and process indicators.

RESULTS

Mean D-to-W time decreased from 124.9 ± 29.8 minutes in the control group to 60.8 ± 15.2 minutes in the intervention group (p < 0.001), with an adjusted mean difference of -64.1 minutes (95% CI: -72.9 to -55.3). The ECG-to-catheterization-laboratory activation segment contributed most to the reduction (41.2%). In-hospital mortality, acute heart failure, and reinfarction did not differ significantly between groups. Process indicators, including ED bypass rate and WeChat response time, improved significantly.

CONCLUSION

The PDCA-based QI initiative substantially reduced D-to-W time by optimizing key STEMI workflow segments. Larger studies with longer follow-up are needed to assess clinical outcome benefits.