http://archinte.ama-

http://archinte.ama- assn.org/cgi/content/abstract/171/ 21/ 1879?maxtoshow=&hits=10&RESULTFOR MAT=&fulltext=DOOR-IN+TO+DOOR- OUT&searchid=l&FIRSTINDEX=08cresourcetype=HWCIT ARCHIVES INTERNAL ci MEDICINE Vol. 171 No. 21, November 28, 2011 Original Investigation HEALTH CARE REFORM National Performance on Door-In to Door-Out Time Among Patients Transferred for Primary Percutaneous Coronary Intervention leph Herrin, PhD; Lauren E. Miller, MS; Dima F. Turkmani, MPH, MBA; Wato Nsa, MD, PhD; Elizabeth E. Drye, MD, SM; Susannah M. Bernheim, MD, MHS; Shari M. Ling, MD; Michael T. Rapp, MD, JD; Lein F. Han, PhD; Dale W. Bratzler, DO, MPH; Elizabeth H. Bradley, PhD; Brahmajee K. Nallamothu, MD, MPH; Henry H. Ting, MD, MBA; Harlan M. Krumholz, MD, SM Arch Intern Med. 2011;171(21):1879-1886. doi:10.1001/archinternmed.2011.481 Background Delays in treatment time are commonplace for patients with ST-segment elevation acute myocardial infarction who must be transferred to another hospital for percutaneous coronary intervention. Experts have recommended that door-in to door-out (DIDO) time (ie, time from arrival at the first hospital to transfer from that hospital to the percutaneous coronary intervention hospital) should not exceed 30 minutes. We sought to describe national performance in DIDO time using a new measure developed by the Centers for Medicare & Medicaid Services. Methods We report national median DIDO time and examine associations with patient characteristics (age, sex, race, contraindication to fibrinolytic therapy, and arrival time) and hospital characteristics (number of beds, geographic region, location [rural or urban], and number of cases reported) using a mixed effects multivariable model. Results Among 13 776 included patients from 1034 hospitals, only 1343 (9.7%) had a DIDO time within 30 minutes, and DIDO exceeded 90 minutes for 4267 patients (31.0%). Mean estimated times (95% CI) to transfer based on multivariable analysis were 8.9 (5.6- 12.2) minutes longer for women, 9.1 (2.7-16.0) minutes longer for African Americans, 6.9 (1.6-11.9) minutes longer for patients with contraindication to fibrinolytic therapy, shorter for all age categories (except >75 years) relative to the category of 18 to 35 years, 15.3 (7.3-23.5) minutes longer for rural hospitals, and 14.4 (6.6-21.3) minutes longer for hospitals with 9 or fewer transfers vs 15 or more in 2009 (all P < .001). EFTA00608201 Conclusion Among patients presenting to emergency departments and requiring transfer to another facility for percutaneous coronary intervention, the DIDO time rarely met the recommended 30 minutes. Author Affiliations: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut (Drs Herrin, Drye, and Krumholz); Health Research and Educational Trust, Chicago, Illinois (Dr Herrin); Oklahoma Foundation for Medical Quality, Oklahoma City (Drs Nsa and Bratzler and Mss Miller and Turkmani); Taybah for Healthcare Consulting, Dallas, Texas (Ms Turkmani); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven (Drs Drye, Bemheim, and Krumholz); Centers for Medicare & Medicaid Services, Baltimore, Maryland (Drs Ling, Rapp, and Han); Section of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC (Dr Rapp); Oklahoma University Health Sciences Center, College of Public Health, Oklahoma City (Dr Bratzler); Section of Health Policy and Administration, Yale School of Public Health, and the Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven (Drs Bradley and Krumholz); The Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence, and the Division of Cardiovascular Medicine and Center for Healthcare Outcomes and Policy, University of Michigan Medical School, Ann Arbor (Dr Nallamothu); and Knowledge and Encounter Research Unit, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota (Dr Ting). Ms Turkmani was employed by Yale University at the initiation of the project that led to this publication. RELATED ARTICLES Reconsidering Transfer for Percutaneous Coronary Intervention Strategy: Time Is of the Essence Rita F. Redberg Arch Intern Med. 2011;0(2011):20115662-2. EXTRACT I FULL TEXT Improvement in Revascularization Time After Creation of a Coronary Catheterization Laboratory at a Public Hospital Eric A. Secemsky, David Lange, Jennifer E. Ho, Kimberly Brayton, Peter A. Ganz, Genevieve Farr, John S. MacGregor, and Priscilla Y. Hsue Arch Intern Med. 2011;0(2011):20115641-2. EXTRACT I FULL TEXT Prognostic Impact of Hospital Readmissions After Primary Percutaneous Coronary Intervention Gianluca Campo, Francesco Saia, Paolo Guastaroba, Jlenia Marchesini, Elisabetta Varani, Antonio Manari, Filippo Ottani, Stefano Tondi, Rossana De Palma, and Antonio Marzocchi Arch Intern Med. 2011;171(21):1948-1949. EXTRACT I FULL TEXT EFTA00608202 THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES Emergency Department Delays for Patients Transferred for PCI JWatch Emergency Med. 2011;2011:3-3. FULL TEXT Reconsidering Transfer for Percutaneous Coronary Intervention Strategy: Time Is of the Essence Red berg Arch Intern Med 2011;0:archinternmed.2011.566v1-2. FULL TEXT EFTA00608203