2.50
Hdl Handle:
http://hdl.handle.net/10755/162475
Type:
Presentation
Title:
Improving Outcomes for STEMI Patients in a Community Hospital
Abstract:
Improving Outcomes for STEMI Patients in a Community Hospital
Conference Sponsor:Emergency Nurses Association
Conference Year:2008
Author:Kratz, Ann, RN, MSN, APRN-BC, APNP
P.I. Institution Name:Aurora Medical Center: Washington County
Title:Clinical Nurse Specialist Emergency Room
Contact Address:1032 East Sumner Street, Hartford, WI, 53027, USA
Contact Telephone:262-670-7585
[Clinical Poster] Clinical Topic: Direct percutaneous coronary intervention (PCI) is the preferred method of reperfusion for ST-elevation myocardial infarction (STEMI). In Europe, transfer from community hospitals to PCI centers increases availability for direct PCI, which improves outcomes as compared to fibrinolysis. It has been difficult to achieve similar door-to-balloon times for transfer patients in the United States especially when the STEMI occurs in a community hospital that does not provide PCI. In 2001, only 23% of US hospitals performed PCI. It is estimated that two thirds of patients with STEMI in the United States present to hospitals without cardiac catheterization labs. The purpose of this project was to improve patient outcomes through the development of an interdisciplinary process to ensure rapid and efficient transfer of patients with the diagnosis of STEMI from a community hospital to a tertiary care facility over 38 miles away. The initial setting was Aurora Medical Center: Washington County AMC-WC), a rural community hospital, with seamless access to Aurora St. Luke's Medical Center, a tertiary medical center. The patients included in this project were all patients entering the emergency room with an ST myocardial infarction from 2005-2007.

Implementation: The evidence-based literature was reviewed and an interdisciplinary team was formed to improve outcomes. The team conducted a retrospective chart review as well as participated in a prospective qualitative study utilizing a continuous quality improvement design. The chart review evaluated baseline practice. The study interventions included partnering with the local EMS systems as well as the tertiary care facility for improved access and transfer capabilities as well as the development and implementation of protocol for STEMI patients. The project included quality improvement tools as well as time study data to improve the processes to ensure rapid transport to the tertiary facility. After the literature and chart review, the Emergency Department staff implemented protocols and guidelines to improve efficiencies in diagnosis and transfer of STEMI patients.

Outcomes: As a result of this project, door to balloon times were reduced the first year from an average of 175 minutes to an average of 113 minutes. The door to transfer time after implementation was 45 minutes. The second year this time was further reduced to 32 minutes. In 2007, the door to EKG time for any patient presenting to the Emergency Department of the AMC-WC was 5.6 minutes with a goal of less than ten minutes. Also, as a result, there was a significant decrease in cardiac damage as well as a decreased length of stay post PCI.

Recommendations: The utilization of evidence-based literature along with interdisciplinary and inter-facility collaboration was effective in improving outcomes for STEMI patients entering this community hospital without PCI capability. Continued improvement in diagnosis and transfer times is recommended to further improve patient outcomes. Nurses in rural emergency departments can improve PCI times and outcomes when utilizing a remote catheterization lab. Rural medical centers could replicate this project to improve the care of patients.
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.titleImproving Outcomes for STEMI Patients in a Community Hospitalen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162475-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Improving Outcomes for STEMI Patients in a Community Hospital</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">Kratz, Ann, RN, MSN, APRN-BC, APNP</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Aurora Medical Center: Washington County</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Nurse Specialist Emergency Room</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">1032 East Sumner Street, Hartford, WI, 53027, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">262-670-7585</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">ann.kratz@aurora.org</td></tr><tr><td colspan="2" class="item-abstract">[Clinical Poster] Clinical Topic: Direct percutaneous coronary intervention (PCI) is the preferred method of reperfusion for ST-elevation myocardial infarction (STEMI). In Europe, transfer from community hospitals to PCI centers increases availability for direct PCI, which improves outcomes as compared to fibrinolysis. It has been difficult to achieve similar door-to-balloon times for transfer patients in the United States especially when the STEMI occurs in a community hospital that does not provide PCI. In 2001, only 23% of US hospitals performed PCI. It is estimated that two thirds of patients with STEMI in the United States present to hospitals without cardiac catheterization labs. The purpose of this project was to improve patient outcomes through the development of an interdisciplinary process to ensure rapid and efficient transfer of patients with the diagnosis of STEMI from a community hospital to a tertiary care facility over 38 miles away. The initial setting was Aurora Medical Center: Washington County AMC-WC), a rural community hospital, with seamless access to Aurora St. Luke's Medical Center, a tertiary medical center. The patients included in this project were all patients entering the emergency room with an ST myocardial infarction from 2005-2007.<br/><br/>Implementation: The evidence-based literature was reviewed and an interdisciplinary team was formed to improve outcomes. The team conducted a retrospective chart review as well as participated in a prospective qualitative study utilizing a continuous quality improvement design. The chart review evaluated baseline practice. The study interventions included partnering with the local EMS systems as well as the tertiary care facility for improved access and transfer capabilities as well as the development and implementation of protocol for STEMI patients. The project included quality improvement tools as well as time study data to improve the processes to ensure rapid transport to the tertiary facility. After the literature and chart review, the Emergency Department staff implemented protocols and guidelines to improve efficiencies in diagnosis and transfer of STEMI patients. <br/><br/>Outcomes: As a result of this project, door to balloon times were reduced the first year from an average of 175 minutes to an average of 113 minutes. The door to transfer time after implementation was 45 minutes. The second year this time was further reduced to 32 minutes. In 2007, the door to EKG time for any patient presenting to the Emergency Department of the AMC-WC was 5.6 minutes with a goal of less than ten minutes. Also, as a result, there was a significant decrease in cardiac damage as well as a decreased length of stay post PCI. <br/><br/>Recommendations: The utilization of evidence-based literature along with interdisciplinary and inter-facility collaboration was effective in improving outcomes for STEMI patients entering this community hospital without PCI capability. Continued improvement in diagnosis and transfer times is recommended to further improve patient outcomes. Nurses in rural emergency departments can improve PCI times and outcomes when utilizing a remote catheterization lab. Rural medical centers could replicate this project to improve the care of patients.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:28:50Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:28:50Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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