Reducing time delay in the thrombolysis of myocardial infarction: An internal quality improvement project

The objectives of this study were to improve thrombolytic therapy in acute myocardial infarction by reducing the "door-to-needle" time in a 285-bed un iversity hospital in Spain. A quality management approach was used involvin g all the relevant staff. Target standard was set at 35 minutes. Baseline d ata, intervention effect, and continuous monitoring were analyzed using x c ontrol charts. Analysis of baseline data showed a wide out of-control varia tion and 72 minutes' average delay. Cause analysis revealed organizational and clinical problems that were subjected to intervention. Postintervention data showed a stable process, with an average of 30 minutes. Continuous mo nitoring showed further improvement in average time and predictable variati on. The template of the current control chart has an average of 26 minutes. Quality management methods, particularly staff involvement in problem anal ysis and intervention design, and the use of control charts were useful to understand, solve, and continuously monitor an important clinical problem w hose existence was evident only after it was measured.