Anne Ford

Date of Award


Document Type

Independent Study

Degree Name

Master of Science in Nursing (MSN)


In the tertiary care setting, there is a gap in the recommended door-to-balloon time of less than 90 minutes when treating a patient with an acute myocardial infarction (AMI). Data show significantly decreased mortality when percutaneous coronary intervention (PCI) is initiated within 90 minutes of the onset of an AMI. According to an Institute of Healthcare Improvement (IHI) report, there are recommended interventions with goals for door-to-balloon times (Mayo Clinic, 2011 ). Tertiary hospitals frequently transport their AMI patients out to a specialty cardiac center. These patients typically do not receive the recommended PCI and the delay in treatment increases the risk for poor patient outcomes

A comprehensive literature review was conducted with the goal of collecting evidencebased data for determination of best practices in the management of patients presenting with AMI at tertiary hospitals. A step-by-step guide was developed for the management of patients presenting with an AMI that reflects best practice, including expert consult by a cardiologist. A cardiologist also evaluated the guideline for accuracy and feasibility. Findings were presented to health care providers at a designated tertiary hospital to promote utilization of the step-by-step guidelines to achieve the recommended 90-minute door-to-balloon time

The anticipated result of this project would be the development of a guideline for AMI patients who present to tertiary ERs with complaints of chest pain. Dissemination of this guideline to the health care providers responsible for triage of patients with acute chest pain at tertiary hospitals is anticipated to improve patient outcomes through the use of evidence based practice guidelines