2.50
Hdl Handle:
http://hdl.handle.net/10755/162552
Type:
Presentation
Title:
PCI: Beating the Time
Abstract:
PCI: Beating the Time
Conference Sponsor:Emergency Nurses Association
Conference Year:2009
Author:Westover, Peggy, RN, BSN
P.I. Institution Name:Sinai Hospital of Baltimore
Title:Clinical Leader
Contact Address:2401 W. Belvedere Ave., Baltimore, MD, 21215, USA
Contact Telephone:410-601-6167
[Annual Conference] Clinical Topic: Prompt recognition and timely treatment for ST Elevation MI (STEMI) patients continues to be a challenging patient safety issue for all Emergency Departments (ED). Each year, almost 400,000 people suffer from a STEMI heart attack. The American College of Cardiologists and The American Heart Association recommended treatment for STEMI patients is prompt Percutaneous Coronary Intervention (PCI) within 90 minutes of arrival to an Emergency Department. Only about 40% of patients receive PCI within the recommended time.

Implementation: In 2006 our average door to balloon (DTB) time was 164 minutes. We created a multidisciplinary task force including ED and Cath lab staff RNs, Advanced Practice Nurses, Cardiologists, ED Medical Director, ED Nursing Director, Risk Management, and Cath Lab Nursing Director to look at our current process, evaluate current literature and develop a plan to decrease our DTB time. A STEMI Guideline was developed providing staff with a structured system for focused patient care when an identified STEMI patient arrives in the ED. Upon recognition of an acute STEMI, an overhead announcement alerts the ED "team" to begin simultaneously preparing the patient for prompt admission to the cath lab. Identifying communication between the ED and cath lab as one of our barriers, a separate phone was installed for cath lab staff to notify ED staff of their readiness for the patient. A small timer attached to the patient upon arrival serves as a constant visual reminder for the entire team, of the 90-minute window. In addition, collaboration with our Emergency Medical System is an integral part of our STEMI Guideline. Early consultation with subsequent confirmation of STEMI by the ED physician, and patient is transported directly to the cath lab. This strategy led to our fastest DTB time in 2008 of 22 minutes, total ED time of 9 minutes. The charge nurse completes a time checklist on every patient, allowing for evaluation of our process, which includes retrospective chart review.

Outcomes: Our STEMI Guideline was implemented in October 2007 with immediate results. After implementation, our average DTB time for 2007 was 95 minutes, compared to our average DTB time of 164 min for 2006. We have continued our success with an average DTB time of 89 minutes for 2008. The Task Force meets monthly to review all STEMI cases including an in-depth analysis of each phase of the process. This assists us in ensuring continued success and evaluating the need for change.

Recommendations: With only about 40% of patients receiving PCI within 90 minutes of hospital arrival, Emergency Departments must develop a specific system for this patient population. Mastering a process is also critical due to future accreditation and regionalization of cardiac care. Timely Percutaneous Coronary Intervention for STEMI patients increases the likelihood of survival. The success of our STEMI Guideline resulted from a multidisciplinary team approach, concentrating on analyzing data, removing barriers, and resolving system issues to get these patients to the cath lab.
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.titlePCI: Beating the Timeen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162552-
dc.description.abstract<table><tr><td colspan="2" class="item-title">PCI: Beating the Time</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">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Westover, Peggy, RN, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Sinai Hospital of Baltimore</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Leader</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2401 W. Belvedere Ave., Baltimore, MD, 21215, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">410-601-6167</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">pwestove@lifebridgehealth.org</td></tr><tr><td colspan="2" class="item-abstract">[Annual Conference] Clinical Topic: Prompt recognition and timely treatment for ST Elevation MI (STEMI) patients continues to be a challenging patient safety issue for all Emergency Departments (ED). Each year, almost 400,000 people suffer from a STEMI heart attack. The American College of Cardiologists and The American Heart Association recommended treatment for STEMI patients is prompt Percutaneous Coronary Intervention (PCI) within 90 minutes of arrival to an Emergency Department. Only about 40% of patients receive PCI within the recommended time.<br/><br/>Implementation: In 2006 our average door to balloon (DTB) time was 164 minutes. We created a multidisciplinary task force including ED and Cath lab staff RNs, Advanced Practice Nurses, Cardiologists, ED Medical Director, ED Nursing Director, Risk Management, and Cath Lab Nursing Director to look at our current process, evaluate current literature and develop a plan to decrease our DTB time. A STEMI Guideline was developed providing staff with a structured system for focused patient care when an identified STEMI patient arrives in the ED. Upon recognition of an acute STEMI, an overhead announcement alerts the ED &quot;team&quot; to begin simultaneously preparing the patient for prompt admission to the cath lab. Identifying communication between the ED and cath lab as one of our barriers, a separate phone was installed for cath lab staff to notify ED staff of their readiness for the patient. A small timer attached to the patient upon arrival serves as a constant visual reminder for the entire team, of the 90-minute window. In addition, collaboration with our Emergency Medical System is an integral part of our STEMI Guideline. Early consultation with subsequent confirmation of STEMI by the ED physician, and patient is transported directly to the cath lab. This strategy led to our fastest DTB time in 2008 of 22 minutes, total ED time of 9 minutes. The charge nurse completes a time checklist on every patient, allowing for evaluation of our process, which includes retrospective chart review. <br/><br/>Outcomes: Our STEMI Guideline was implemented in October 2007 with immediate results. After implementation, our average DTB time for 2007 was 95 minutes, compared to our average DTB time of 164 min for 2006. We have continued our success with an average DTB time of 89 minutes for 2008. The Task Force meets monthly to review all STEMI cases including an in-depth analysis of each phase of the process. This assists us in ensuring continued success and evaluating the need for change.<br/><br/>Recommendations: With only about 40% of patients receiving PCI within 90 minutes of hospital arrival, Emergency Departments must develop a specific system for this patient population. Mastering a process is also critical due to future accreditation and regionalization of cardiac care. Timely Percutaneous Coronary Intervention for STEMI patients increases the likelihood of survival. The success of our STEMI Guideline resulted from a multidisciplinary team approach, concentrating on analyzing data, removing barriers, and resolving system issues to get these patients to the cath lab.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:30:07Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:30:07Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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