2.50
Hdl Handle:
http://hdl.handle.net/10755/162488
Type:
Presentation
Title:
Minimizing Time Delays to PCI in a Community Hospital
Abstract:
Minimizing Time Delays to PCI in a Community Hospital
Conference Sponsor:Emergency Nurses Association
Conference Year:2008
Author:Stickel, David, RN, BSN, EMT-B
P.I. Institution Name:The Christ Hospital
Title:Assistant Clinical Manager
Contact Address:2139 Auburn Avenue, Cincinnati, OH, 45219, USA
Contact Telephone:513-585-3250
Co-Authors:Gail Merritt, RN, BS and Jeanie Hawkins, RN, MS, CEN
[Clinical Poster] Clinical Topic: The recommended maximum time per ACA/AHA guidelines for door to balloon time (DTBT) is 90 minutes. In 2005 only 46% of the ST Elevation Myocardial Infarction (STEMI) patients achieved that time. A performance improvement initiative involving multiple disciplines attempted to improve DTBT in this 555-bed hospital.

Implementation: Six Sigma methodologies of Define, Measure, Analyze, Improve, and Control were utilized for this performance improvement initiative. In addition, the following processes were improved/initiated:
1. Life squads were outfitted with equipment for 12 lead EKG transmittal
2. ED physician activates interventional cardiologist and cath lab
3. Staff tracks the process intervals
4. Monthly reporting at housewide committees
5. Individual data reported quarterly to cardiologists, emergency room physicians, and EMS teams
6. Performance is reviewed with Physicians and staff in live meetings.
7. All Emergency Department Registered Nurses and Patient Care Technicians were 12 Lead EKG certified
8. Patient Care Assistant was placed in Triage

Outcomes: Process changes implemented in September of 2005 resulted in a decreased DTBT. In Q1CY05 mean = 142 minutes, SD = 79.5 minutes. Q4CY05 was the turning point. Reduced standard deviation demonstrates the required control for an improved mean. Sustained improvements have occurred over 15 months with minimal variation.
Q2CY07 mean = 61 minutes, SD = 20 minutes. Multidisciplinary process can effectively and statistically improve (ANOVA, p=0.000 - Pre vs. Post. ANOVA p=0.001 - by month) time delays for STEMI treatment. DTBT in CY06 was 100 minutes for patients arriving by personal transportation. The time decreased to 66 minutes after the implementation of a PCA at triage and the ED RNs were trained to perform 12 lead ECG.

Recommendations: Recommendations include a structured control plan for ongoing learning and sustainability. In addition, decreasing variation in processes improve DTBT resulting in more immediate reperfusion. Improved partnership between EMS, Physicians, Emergency Department and Cath Lab staff improves patient outcomes.
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.titleMinimizing Time Delays to PCI in a Community Hospitalen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162488-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Minimizing Time Delays to PCI 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">Stickel, David, RN, BSN, EMT-B</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">The Christ Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Clinical Manager</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2139 Auburn Avenue, Cincinnati, OH, 45219, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">513-585-3250</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">stickedw@healthall.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Gail Merritt, RN, BS and Jeanie Hawkins, RN, MS, CEN</td></tr><tr><td colspan="2" class="item-abstract">[Clinical Poster] Clinical Topic: The recommended maximum time per ACA/AHA guidelines for door to balloon time (DTBT) is 90 minutes. In 2005 only 46% of the ST Elevation Myocardial Infarction (STEMI) patients achieved that time. A performance improvement initiative involving multiple disciplines attempted to improve DTBT in this 555-bed hospital.<br/><br/>Implementation: Six Sigma methodologies of Define, Measure, Analyze, Improve, and Control were utilized for this performance improvement initiative. In addition, the following processes were improved/initiated:<br/>1. Life squads were outfitted with equipment for 12 lead EKG transmittal<br/>2. ED physician activates interventional cardiologist and cath lab<br/>3. Staff tracks the process intervals<br/>4. Monthly reporting at housewide committees <br/>5. Individual data reported quarterly to cardiologists, emergency room physicians, and EMS teams<br/>6. Performance is reviewed with Physicians and staff in live meetings.<br/>7. All Emergency Department Registered Nurses and Patient Care Technicians were 12 Lead EKG certified<br/>8. Patient Care Assistant was placed in Triage<br/><br/>Outcomes: Process changes implemented in September of 2005 resulted in a decreased DTBT. In Q1CY05 mean = 142 minutes, SD = 79.5 minutes. Q4CY05 was the turning point. Reduced standard deviation demonstrates the required control for an improved mean. Sustained improvements have occurred over 15 months with minimal variation.<br/>Q2CY07 mean = 61 minutes, SD = 20 minutes. Multidisciplinary process can effectively and statistically improve (ANOVA, p=0.000 - Pre vs. Post. ANOVA p=0.001 - by month) time delays for STEMI treatment. DTBT in CY06 was 100 minutes for patients arriving by personal transportation. The time decreased to 66 minutes after the implementation of a PCA at triage and the ED RNs were trained to perform 12 lead ECG.<br/><br/>Recommendations: Recommendations include a structured control plan for ongoing learning and sustainability. In addition, decreasing variation in processes improve DTBT resulting in more immediate reperfusion. Improved partnership between EMS, Physicians, Emergency Department and Cath Lab staff improves patient outcomes.</td></tr></table>en_GB
dc.date.available2011-10-27T10:29:03Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:29:03Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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