2.50
Hdl Handle:
http://hdl.handle.net/10755/162706
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:Merritt, Gail, RN, BS
P.I. Institution Name:The Christ Hospital
Title:Clinical Educator
Contact Address:, Cincinnati, OH, 45219-, USA
Contact Telephone:(513) 585-1046
Co-Authors:Gloria J. Hawkins, RN, MS; Heather Grooms, PT, MBA
Purpose: Minimizing time delays from the ED arrival for the ST segment elevated myocardial infarction (STEMI) patient to balloon inflation (DTBT). Recommended maximum time per ACA/AHA/SCAI guidelines for DTBT is 90 minutes. In 2005 46% of STEMI patients achieved that time (NRMI, 2005). Through a performance improvement initiative involving pre-hospital 12-lead ECG transmittal, multi-disciplinary and collaborative physician effort, an attempt was made to improve DTBT in a 555 bed hospital.

Design: The Six Sigma methodology of Define, Measure, Analyze, Improve, Control (DMAIC) was used.

Setting: 555 bed community hospital.

Participants/Subjects: EMS providers, multidisciplinary and collaborative physicians, nurses and patients with STEMI.

Methods: The Six Sigma methodology was utilized. Improved processes:
1. Life squads outfitted with equipment for 12 lead ECG transmittal or fax capabilities;
2. ED physicians activates interventional cardiologist and cath lab;
3. Staff track process intervals;
4. Monthly reporting at committees;
5. Individual data reported quarterly to cardiologists, emergency room physicians, EMS teams;
6. Process intervals tracked;
7. Performance reviewed with physicians and staff in live meetings;
8. Train nurses to perform 12 lead ECG;
9. PCA at triage.

Results: Process changes implemented in September 2005 resulted in 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: Decrease variation in processes to improve DTBT and immediate reperfusion. Partnership with EMS, physicians, ED and cath lab staff to improve patient outcomes. A structured control plan for ongoing learning and sustainability.
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/10755/162706-
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">Merritt, Gail, RN, BS</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">Clinical Educator</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">, Cincinnati, OH, 45219-, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(513) 585-1046</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">merritgc@healthall.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Gloria J. Hawkins, RN, MS; Heather Grooms, PT, MBA</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Minimizing time delays from the ED arrival for the ST segment elevated myocardial infarction (STEMI) patient to balloon inflation (DTBT). Recommended maximum time per ACA/AHA/SCAI guidelines for DTBT is 90 minutes. In 2005 46% of STEMI patients achieved that time (NRMI, 2005). Through a performance improvement initiative involving pre-hospital 12-lead ECG transmittal, multi-disciplinary and collaborative physician effort, an attempt was made to improve DTBT in a 555 bed hospital.<br/><br/>Design: The Six Sigma methodology of Define, Measure, Analyze, Improve, Control (DMAIC) was used.<br/><br/>Setting: 555 bed community hospital.<br/><br/>Participants/Subjects: EMS providers, multidisciplinary and collaborative physicians, nurses and patients with STEMI.<br/><br/>Methods: The Six Sigma methodology was utilized. Improved processes:<br/>1. Life squads outfitted with equipment for 12 lead ECG transmittal or fax capabilities;<br/>2. ED physicians activates interventional cardiologist and cath lab;<br/>3. Staff track process intervals;<br/>4. Monthly reporting at committees;<br/>5. Individual data reported quarterly to cardiologists, emergency room physicians, EMS teams;<br/>6. Process intervals tracked;<br/>7. Performance reviewed with physicians and staff in live meetings;<br/>8. Train nurses to perform 12 lead ECG;<br/>9. PCA at triage.<br/><br/>Results: Process changes implemented in September 2005 resulted in decreased DTBT. In Q1CY05 mean = 142 minutes, SD = 79.5 minutes. Q4CY05 was the turning point.<br/><br/>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.<br/>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.<br/>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: Decrease variation in processes to improve DTBT and immediate reperfusion. Partnership with EMS, physicians, ED and cath lab staff to improve patient outcomes. A structured control plan for ongoing learning and sustainability.</td></tr></table>en_GB
dc.date.available2011-10-27T10:32:45Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:32:45Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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