Reperfusion therapy with percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) has understandably received considerable attention in quality measurement and improvement initiatives. STEMI is a common condition with high mortality. The benefits of reperfusion therapy can be substantial but are time sensitive.1 However, important gaps exist between the patterns of treatment in the community and the ideal benchmarks established in evidence-based practice guidelines.2 The timeliness of primary PCI, or “door-to-balloon” time, has emerged as one of a handful of quality measures reported to the public for the care of patients with acute myocardial infarction3 and serves as the focus of both regional4,5 and national initiatives6,7 to improve care quality.