A Collaborative Approach to Reducing Door-to-Balloon Time in STEMI: Small Changes Can Make a Big Difference

2.50
Hdl Handle:
http://hdl.handle.net/10755/162466
Type:
Presentation
Title:
A Collaborative Approach to Reducing Door-to-Balloon Time in STEMI: Small Changes Can Make a Big Difference
Abstract:
A Collaborative Approach to Reducing Door-to-Balloon Time in STEMI: Small Changes Can Make a Big Difference
Conference Sponsor:Emergency Nurses Association
Conference Year:2008
Author:Boldt, Robin A., RN, BSN
P.I. Institution Name:Clarian Health Partners/Methodist Hospital of Indiana
Title:Partner/Charge Nurse, Emergency Medicine and Trauma Center
Contact Address:1701 North Senate Blvd., Indianapolis, IN, 46202, USA
Contact Telephone:317-962-8880
[Clinical Poster] Clinical Topic: Prompt reperfusion therapy can improve survival and limit myocardial damage in patients presenting to the emergency department (ED) with ST-segment elevation myocardial infarction (STEMI). The national standard recommended by the American College of Cardiology and American Heart Association for door-to-balloon inflation is equal to or less than 90 minutes. A median door-to-balloon time of equal to or less than 90 minutes is also recognized by the Joint Commission as a measure of the quality of care delivered to patients with STEMI. Despite these recommendations, most hospitals do not meet the standard. Our ED began a collaborative effort with the Cardiac Catheterization Lab with a goal of meeting this benchmark.

Implementation: Regular meetings between the ED and Cath Lab began in late 2004. Goals were to identify factors that created delays in transferring patients to Cath Lab and develop strategies to minimize time spent in the ED, thus reducing the door to balloon time. After barriers were identified, the group implemented solutions for each department. The ED determined that STEMI diagnosis was often delayed due to the limited number of ECG machines available, causing the door to ECG time to routinely exceed the recommended average of equal to or less than 10 minutes. Other barriers included an inadequate number of transport monitors, forms and small equipment required for transfer were not stored together for rapid access, and inconsistent communication regarding the status of the pending transfer between the bedside ED nurse, ED physician, and Cath Lab staff. Solutions implemented included purchasing twelve ECG machines, dedicating two new portable monitors to Cath Lab transport, consolidating all forms and small equipment in a "little black bag" to be opened by the bedside nurse when STEMI is identified, and a structured method of communication that included the ED Charge nurse, bedside nurses, ED physician, and the Cath Lab team. Cath Lab delays most often occurred when procedures were performed outside normal business hours. Previously, as many as five telephone calls and pages were made as the ED physician consulted the cardiologist, who then activated the Cath Lab team. Delays also occurred when Cath Lab staff experienced difficulty quickly parking, waited to begin patient transport until all three team members arrived, spent time changing into hospital scrubs, and delayed the transfer until the procedure room was prepared for the patient. Solutions implemented included activation of the Cath Lab team by the ED physician, allowing the team to wear scrubs to the hospital, having designated parking spots for the Cath Lab team in close proximity to the ED, with the person taking the last parking space going directly to the ED to transport the patient, and leaving a room set up at the end of each day in anticipation of a patient.

Outcomes: Door to balloon statistics are compiled quarterly. Statistics for Q1 2005 showed a median door to balloon inflation time of 103 minutes. In Q3 2007, the median door-to-balloon time has fallen to 80 minutes. Since the purchase of additional ECG machines, the ED's door to initial ECG time has fallen from an average of 16 minutes (Q4 2004) to 7 minutes in Q3 2007.

Recommendations: Decreasing door-to-balloon time has been shown to improve outcomes in patients with STEMI. Collaboration between departments can produce many small changes in procedures that can have a large impact on decreasing door to balloon time and improving the quality of care.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleA Collaborative Approach to Reducing Door-to-Balloon Time in STEMI: Small Changes Can Make a Big Differenceen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162466-
dc.description.abstract<table><tr><td colspan="2" class="item-title">A Collaborative Approach to Reducing Door-to-Balloon Time in STEMI: Small Changes Can Make a Big Difference</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2008</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Boldt, Robin A., RN, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Clarian Health Partners/Methodist Hospital of Indiana</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Partner/Charge Nurse, Emergency Medicine and Trauma Center</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">1701 North Senate Blvd., Indianapolis, IN, 46202, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">317-962-8880</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">rboldt@clarian.org</td></tr><tr><td colspan="2" class="item-abstract">[Clinical Poster] Clinical Topic: Prompt reperfusion therapy can improve survival and limit myocardial damage in patients presenting to the emergency department (ED) with ST-segment elevation myocardial infarction (STEMI). The national standard recommended by the American College of Cardiology and American Heart Association for door-to-balloon inflation is equal to or less than 90 minutes. A median door-to-balloon time of equal to or less than 90 minutes is also recognized by the Joint Commission as a measure of the quality of care delivered to patients with STEMI. Despite these recommendations, most hospitals do not meet the standard. Our ED began a collaborative effort with the Cardiac Catheterization Lab with a goal of meeting this benchmark. <br/><br/>Implementation: Regular meetings between the ED and Cath Lab began in late 2004. Goals were to identify factors that created delays in transferring patients to Cath Lab and develop strategies to minimize time spent in the ED, thus reducing the door to balloon time. After barriers were identified, the group implemented solutions for each department. The ED determined that STEMI diagnosis was often delayed due to the limited number of ECG machines available, causing the door to ECG time to routinely exceed the recommended average of equal to or less than 10 minutes. Other barriers included an inadequate number of transport monitors, forms and small equipment required for transfer were not stored together for rapid access, and inconsistent communication regarding the status of the pending transfer between the bedside ED nurse, ED physician, and Cath Lab staff. Solutions implemented included purchasing twelve ECG machines, dedicating two new portable monitors to Cath Lab transport, consolidating all forms and small equipment in a &quot;little black bag&quot; to be opened by the bedside nurse when STEMI is identified, and a structured method of communication that included the ED Charge nurse, bedside nurses, ED physician, and the Cath Lab team. Cath Lab delays most often occurred when procedures were performed outside normal business hours. Previously, as many as five telephone calls and pages were made as the ED physician consulted the cardiologist, who then activated the Cath Lab team. Delays also occurred when Cath Lab staff experienced difficulty quickly parking, waited to begin patient transport until all three team members arrived, spent time changing into hospital scrubs, and delayed the transfer until the procedure room was prepared for the patient. Solutions implemented included activation of the Cath Lab team by the ED physician, allowing the team to wear scrubs to the hospital, having designated parking spots for the Cath Lab team in close proximity to the ED, with the person taking the last parking space going directly to the ED to transport the patient, and leaving a room set up at the end of each day in anticipation of a patient.<br/><br/>Outcomes: Door to balloon statistics are compiled quarterly. Statistics for Q1 2005 showed a median door to balloon inflation time of 103 minutes. In Q3 2007, the median door-to-balloon time has fallen to 80 minutes. Since the purchase of additional ECG machines, the ED's door to initial ECG time has fallen from an average of 16 minutes (Q4 2004) to 7 minutes in Q3 2007. <br/><br/>Recommendations: Decreasing door-to-balloon time has been shown to improve outcomes in patients with STEMI. Collaboration between departments can produce many small changes in procedures that can have a large impact on decreasing door to balloon time and improving the quality of care.</td></tr></table>en_GB
dc.date.available2011-10-27T10:28:41Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:28:41Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.