Improving Door-to-Balloon Time through Operational Efficiency and Patient Safety Culture in STEMI Patients: A Hospital-Based Quality Improvement Study

Dr Swati Rai (Chief Manager Operations for A J Hospital & Research Centre. Mangalore. India)
Dr Amitha Marla (Director Medical Administration for A J Hospital & Research Centre, Mangalore. India)
Dr Manjunath B V (HOD, Chief Interventional Cardiologist for A J Hospital & Research Centre, Mangalore. India)
Miss Priyanka K (Statistician cum Academic Coordinator for A J Hospital & Research Centre, Mangalore. India)

Journal of Health Service Administration and Hospital Management
Vol. 2 No. 2 (2026): July, 2026

Background: Timely reperfusion is critical for reducing myocardial damage and mortality in ST-elevation myocardial infarction (STEMI). In many Indian settings, door-to-balloon (DTB) time remains prolonged due to operational and system-level barriers. Objective: To evaluate whether recommended DTB timelines can be achieved in a tertiary care hospital and to identify and address key delay factors. Methods: A prospective study was conducted in a 400-bed tertiary care hospital in South India (Oct 2018–Oct 2019), followed by an intervention phase (Nov 2019–Jan 2020). Phase I (n=282) identified delays using process mapping and Fishbone analysis. Phase II implemented Lean principles and the Plan–Do–Check–Act (PDCA) cycle. Statistical comparison of means was performed, with p < 0.05 considered significant. Results: Mean DTB time reduced from 372 minutes to 208 minutes (p < 0.05). The proportion achieving DTB <120 minutes increased from 24% to 47%. Shorter DTB times were associated with lower mortality. Conclusion: Structured protocols, early activation systems, and continuous quality improvement can significantly reduce DTB time. However, achieving global benchmarks requires sustained system-level strengthening.