Reduction in Door-to-Balloon Time with Training for Effective and Efficient Action in Medical Service-Better Process (TEAMS-BP) at a Community Hospital in Japan

Reduction in Door-to-Balloon Time with Training for Effective and Efficient Action in Medical Service-Better Process (TEAMS-BP) at a Community Hospital in Japan

HIROKI ISONO,^1,2 TETSUHIRO MAENO³ and SHIGEYUKI WATANABE⁴

¹Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
²Department of Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Ibaraki, Japan
³Department of Primary Care and Medical Education, University of Tsukuba, Tsukuba, Ibaraki, Japan
⁴Department of Cardiology, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Ibaraki, Japan

ST-elevation myocardial infarction (STEMI) is a fatal condition. Prompt primary percutaneous coronary intervention is associated with lower mortality. However, community hospitals in Japan lack human and medical resources, and implementation of the same strategies as those used in the USA, such as an on-call cardiologist at the hospital, to achieve a door-to-balloon time of le; 90 min appears particularly challenging. Therefore, we used Training for Effective and Efficient Action in Medical Service-Better Process (TEAMS-BP) to develop a new process and assessed its effectiveness in reducing door-to-balloon time. TEAMS-BP can optimize the process by making the best use of available materials, machines, facilities and manpower. All processes conducted by physicians, nurses, electrocardiogram technicians, radiological technologists, and clerical staff in the emergency room were reviewed, documented, and standardized using the four steps of TEAMS-BP. The following processes were implemented: setting time goals, calling an electrocardiogram technician beforehand, minimizing tasks before calling a cardiologist, confirming the checklist, and providing data feedback. Forty-four STEMI patients who were treated after TEAMS-BP implementation were compared with 58 who were treated before implementation. Median door-to-balloon, door-to-electrocardiogram and door-to-laboratory times were significantly reduced after TEAMS-BP implementation, decreasing from 106 to 82 min, 14 to 6 min, and 67 to 45 min, respectively. In conclusion, implementation of TEAMS-BP improved the door-to-balloon time of STEMI cases without additional resources or costs incurred by the hospital. TEAMS-BP can be implemented by any hospital wishing to develop a new process that accommodates local working conditions.

keywords —— door-to-balloon time; primary percutaneous coronary intervention; quality improvement; ST-elevation myocardial infarction; Training for Effective and Efficient Action in Medical Service-Better Process

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Tohoku J. Exp. Med., 2018, 244, 305-315

Correspondence: Hiroki Isono, M.D., Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.

e-mail: hirokisono@gmail.com