Prompt treatment is essential for patients with ST-segment elevation myocardial infarction (STEMI) who are treated with percutaneous coronary intervention (PCI). However, recent studies indicate that only about one third of hospitals achieve national recommendations5 for door-to-balloon (D2B) times of ≤ 90 minutes. Several key hospital strategies are strongly associated with more rapid D2B times for patients undergoing primary PCI for STEMI; nevertheless, only a minority of hospitals have implemented these strategies.3rnTo speed the adoption of evidence-based strategies to reduce D2B times, in 2006 the American College of Cardiology (ACC) in partnership with 38 other organizations created D2B: An Alliance for Quality. The focus of the effort was on hospitals in the United States, although hospitals elsewhere may also enroll. The goal of the D2B Alliance was for each participating hospital to achieve D2B times of 90 minutes or less for at least 75% of nontrans-fer patients with STEMI through the implementation of evidence-based strategies. These strategies included emergency medicine activation of the catheterization laboratory, catheteri-zation laboratory activation with a single call, explicit expectations of staff arrival within 20-30 minutes of page, prompt data feedback, senior management support, a team-based approach, and activation of the catheterization laboratory on the basis of prehospital electrocardiogram (ECG) results while the patient is still en route to the hospital (an optional strategy).
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