Heart, Lung and Circulation

‘Stemi-sim’—A ‘Process of Care’ Simulation can Help Improve Door to Balloon Times for Patients with ST Elevation Myocardial Infarction

      Aims: To improve ‘door to balloon’ times for patients with ST elevation myocardial infarction (STEMI) through in situ simulation of patient journeys.
      Methods: Multi-disciplinary teams from prehospital providers, emergency (medical, nursing, patient support) and cardiology (medical, nursing, imaging) participated in a series of in situ simulations of the STEMI patient journey. Simulated (manikins and monitor emulators) and standardised patients (trained actors) were used. Participants were required to identify possible candidates for percutaneous coronary intervention, provide assessment and management, communicate effectively between teams and coordinate physical transfer and urgent intervention in the cardiac catheter suite. Data was collected on the performance against time-based targets and quality of care Key Performance Indicators. Door-to-balloon times for real STEMI patients presenting before and after the intervention were analysed using Mann–Whitney tests.
      Results: Four simulations sessions, involving 52 staff were conducted. Median door-to-balloon times at the facility were 76 min in the six months prior to the intervention, and 59 min in the six months after the simulation (p = 0.038), and with a change in the ‘door to lab’ time of 60–27 min in the corresponding time periods (p = 0.003). Important practice changes were identified. These included equipment, staffing, and communication processes, some of which became the subject of other service improvement initiatives.
      Conclusions: A ‘process of care’ simulation program can encourage teams to build relationships across departments and collaborate on improved service delivery. Simulation can be a key element in measurable improvements in patient outcomes.