Background: How quickly percutaneous coronary intervention is performed in patients with a ST-elevation myocardial infarction (STEMI) is a core quality measure, reported as door-to-balloon (D2B) time in minutes. Aims: This retrospective study of 1193 patients was undertaken to explore how well six hospitals in a large healthcare system achieved time from the emergency department (ED) to the first ECG <10 minutes and D2B time ≤90 minutes. Methods: STEMI coordinators provided shelved data collected between 1-1-2016 and 8-31-2018. D2B times were available for 818 patients. The overall median time from the ED to the first ECG was 4 minutes and all hospitals achieved median times less than 10 minutes. There was a significant difference between the hospital with the highest (88%) and lower percentage of patients (79%) attaining the recommended time from the ED to the first ECG <10 minutes (p<0.025). The overall median D2B time for the entire sample was 63 minutes and the difference between D2B time among hospitals was significant (p<0.001). Collectively, the six hospitals achieved a D2B time <90 minutes well above the recommended goal by the American Heart Association (87.8% vs 75% respectively, p<0.001). The most compelling finding was that field STEMI activation with direct patient transportation to the cardiac catheterization laboratory(CCL) resulted in significantly shorter D2B times than ED activation (p<0.001). Patients with D2B time <90 minutes had a lower mortality than those with D2B time >90 minutes (5.3% vs 19.0% respectively, p<0.001). Conclusion: Achieving D2B time <90 minutes has a significant impact on mortality associated with STEMI. Field STEMI activation with direct patient transport to the CCL significantly shortened D2B time. Further study is needed to assess the benefit of close collaboration between hospital and Emergency Medical Service personnel to implement this mode of patient transportation to the CCL to improve STEMI care.