2.50
Hdl Handle:
http://hdl.handle.net/10755/162663
Type:
Presentation
Title:
Improving Door-to-Balloon Time with a Code H Team
Abstract:
Improving Door-to-Balloon Time with a Code H Team
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Maliszewski, Mary, RN, BSN, CCRN
P.I. Institution Name:Stony Brook University Medical Center
Title:Nurse Manager Cardiac Cath Lab
Contact Address:Nicols Rd., Stony Brook, NY, 11794, USA
Contact Telephone:(631) 444-3701
Co-Authors:Anna Rosenthal, RN, MS
[Clinical Poster] Clinical Topic: Not too long ago, door-to-balloon time (DTBT) for patients presenting in the emergency department (ED) with acute myocardial infarction (AMI) typically was greater than 400 minutes. Today, the development of more direct and simplified angioplasty processes has reset the AMI core measure of a DTBT at less than 90 minutes. In 2003, the DTBT for AMI patients at this Level 1 trauma center (also a burn, stroke, and heart center) was measured at 400 minutes. The goal of this initiative was to reduce our DTBT from 400 minutes to the current national benchmark of 90 minutes.

Implementation: A multidisciplinary task force of ED and cardiac catheterization lab (CCL) physicians and nurses as well as emergency medical services, hospital communications, quality management, housekeeping, and distribution services staff met over two months to study current AMI protocol and identify areas in our AMI processes that slowed ED patient transfer to the cardiac catheterization lab. The most significant finding was that multiple layers of phone calls were needed between the two departments and cardiologists before the patient could be transported. In addition, EKGs were either delayed and/or not read promptly, and medication administration was often delayed. Based on these findings, the team developed a new protocol using core measures and evidence-based practice found in the 2002 American College of Cardiology and American Hospital Association guidelines for management of AMI patients. The most significant change was the establishment of a vertically integrated Code H team. This team consists of an interventional cardiologist and fellow, a CCL registered nurse, a cardiovascular technologist, and a radiology technician. A second related change was cutting through the layers of phone calls by implementing a dedicated paging system for the Code H team. Now, if an ECG shows evidence of MI, Code H members can be simultaneously paged and respond within 5 minutes. Patients can then immediately be transferred to the CCL, where they are prepped and receive rapid angiography. Other important protocol changes include the following: triage nurses now have medical authorization to order EKGs for all patients presenting with chest pain or anginal equivalent symptoms as part of the triage process; ED nurses ensure that EKGs are performed within 10 minutes of patients' arrival to the emergency department; EKGs must immediately be read and signed by the attending physician and the ED physician who assesses it for AMI, based on established criteria; a dedicated stretcher must be available at all times in the emergency department; and a Code H kit must be available in the Pyxis medication system, as suggested by ED nurses. In addition, ED nurses no longer have to wait months to find out DTBTs. The new protocol requires that ED and CCL data collection be completed concurrently. In this way, ED staff is informed as soon as possible of final door-to-balloon time within a month's timeframe for each AMI patient as well as patient outcomes. Data also can be evaluated sooner and the process modified as need at monthly team meetings.

Outcomes: Nine months after implementing the new protocol, in particular the formation of the Code H team, the DTBT declined dramatically -from 400 minutes in January 2003, to 83 minutes in October 2003. Additionally, AMI mortality rate and mean length of stay also decreased during this period, from 3.7% to 1.6% (p<0.05) and from five to four days (p<0.05), respectively. The Code H team now meets monthly to monitor practice at all levels and modify protocols in response to both feedback from ED and CCL staff, as well as data analysis of all patients presenting to the emergency department with chest pain and anginal equivalent. Since implementing the new changes, ED nurses report feeling empowered. They are rewarded with a pin and their names announced at staff meetings, when they meet the 90-minute DTBT target.

Recommendations: Providing the best possible care to patients requires ongoing attention to existing protocols and taking appropriate steps to improve them as new research becomes available. As in this case, an analysis of former practices and protocol can reveal areas of weakness and result in remedial actions that improve patient outcomes and saves lives.
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 Door-to-Balloon Time with a Code H Teamen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162663-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Improving Door-to-Balloon Time with a Code H Team</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">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Maliszewski, Mary, RN, BSN, CCRN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Stony Brook University Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Nurse Manager Cardiac Cath Lab</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Nicols Rd., Stony Brook, NY, 11794, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(631) 444-3701</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">Mary.Maliszewski@sunysb.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Anna Rosenthal, RN, MS</td></tr><tr><td colspan="2" class="item-abstract">[Clinical Poster] Clinical Topic: Not too long ago, door-to-balloon time (DTBT) for patients presenting in the emergency department (ED) with acute myocardial infarction (AMI) typically was greater than 400 minutes. Today, the development of more direct and simplified angioplasty processes has reset the AMI core measure of a DTBT at less than 90 minutes. In 2003, the DTBT for AMI patients at this Level 1 trauma center (also a burn, stroke, and heart center) was measured at 400 minutes. The goal of this initiative was to reduce our DTBT from 400 minutes to the current national benchmark of 90 minutes.<br/><br/>Implementation: A multidisciplinary task force of ED and cardiac catheterization lab (CCL) physicians and nurses as well as emergency medical services, hospital communications, quality management, housekeeping, and distribution services staff met over two months to study current AMI protocol and identify areas in our AMI processes that slowed ED patient transfer to the cardiac catheterization lab. The most significant finding was that multiple layers of phone calls were needed between the two departments and cardiologists before the patient could be transported. In addition, EKGs were either delayed and/or not read promptly, and medication administration was often delayed. Based on these findings, the team developed a new protocol using core measures and evidence-based practice found in the 2002 American College of Cardiology and American Hospital Association guidelines for management of AMI patients. The most significant change was the establishment of a vertically integrated Code H team. This team consists of an interventional cardiologist and fellow, a CCL registered nurse, a cardiovascular technologist, and a radiology technician. A second related change was cutting through the layers of phone calls by implementing a dedicated paging system for the Code H team. Now, if an ECG shows evidence of MI, Code H members can be simultaneously paged and respond within 5 minutes. Patients can then immediately be transferred to the CCL, where they are prepped and receive rapid angiography. Other important protocol changes include the following: triage nurses now have medical authorization to order EKGs for all patients presenting with chest pain or anginal equivalent symptoms as part of the triage process; ED nurses ensure that EKGs are performed within 10 minutes of patients' arrival to the emergency department; EKGs must immediately be read and signed by the attending physician and the ED physician who assesses it for AMI, based on established criteria; a dedicated stretcher must be available at all times in the emergency department; and a Code H kit must be available in the Pyxis medication system, as suggested by ED nurses. In addition, ED nurses no longer have to wait months to find out DTBTs. The new protocol requires that ED and CCL data collection be completed concurrently. In this way, ED staff is informed as soon as possible of final door-to-balloon time within a month's timeframe for each AMI patient as well as patient outcomes. Data also can be evaluated sooner and the process modified as need at monthly team meetings.<br/><br/>Outcomes: Nine months after implementing the new protocol, in particular the formation of the Code H team, the DTBT declined dramatically -from 400 minutes in January 2003, to 83 minutes in October 2003. Additionally, AMI mortality rate and mean length of stay also decreased during this period, from 3.7% to 1.6% (p&lt;0.05) and from five to four days (p&lt;0.05), respectively. The Code H team now meets monthly to monitor practice at all levels and modify protocols in response to both feedback from ED and CCL staff, as well as data analysis of all patients presenting to the emergency department with chest pain and anginal equivalent. Since implementing the new changes, ED nurses report feeling empowered. They are rewarded with a pin and their names announced at staff meetings, when they meet the 90-minute DTBT target.<br/><br/>Recommendations: Providing the best possible care to patients requires ongoing attention to existing protocols and taking appropriate steps to improve them as new research becomes available. As in this case, an analysis of former practices and protocol can reveal areas of weakness and result in remedial actions that improve patient outcomes and saves lives.</td></tr></table>en_GB
dc.date.available2011-10-27T10:32:02Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:32:02Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.