Changing Emergency Department Culture to Improve Care for Patients with STEMI: The Primary PCI Project

2.50
Hdl Handle:
http://hdl.handle.net/10755/163012
Type:
Presentation
Title:
Changing Emergency Department Culture to Improve Care for Patients with STEMI: The Primary PCI Project
Abstract:
Changing Emergency Department Culture to Improve Care for Patients with STEMI: The Primary PCI Project
Conference Sponsor:Emergency Nurses Association
Conference Year:2005
Author:Parkosewich, Janet, RN, MSN, CCRN
P.I. Institution Name:Yale-New Haven Hospital
Title:Cardiac Clinical Nurse Specialist
Contact Address:20 York Street, New Haven, CT, 06504, USA
Contact Telephone:(203) 688-2352
Co-Authors:Bertie Chuong, RN, MS, CCRN; Margot Ververis, RN, MSN; Linda Konet, RN, MA; Jaime Gerber, MD; Harry Moscovitz, MD
Purpose: The American College of Cardiology and the American Heart Association (ACC/AHA) recommend treating ST-segment elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI) within 90 (30) minutes of emergency department (ED) arrival. To reduce treatment delays created by inefficient hospital systems, a performance improvement team was convened. The purpose of this study was to examine the effect that ED professional practice and system changes had on reducing time to primary PCI. Design: A descriptive study was conducted to determine adherence to the ACC/AHA standard and hospital performance measures (50 minutes ED door-to-lab time and 40 minutes lab-to-balloon time). Setting/Subjects: All patients admitted with STEMI from 12/98-12/03 to this emergency department, a Level I trauma center located in the Northeast, were included. Approval for conducting this study was obtained from this institution's human subjects research review committee. Methods: Five key success factors for accelerating improvement were applied including committed nurse-physician champions, shared goals, system solutions to eliminate barriers, credible and timely data feedback, and substantial administrative support. The ED nursing director and cardiac clinical nurse specialist, having expert knowledge and skill in practice and performance improvement served as clinical champions. Collaborating with physician champions, the ED culture transformed from one of inertia to urgency. Project interventions included: implementing the STEMI protocol with explicit goals from ED arrival (ECG 10 minutes, ED attending diagnosis 20 minutes, and patient transfer to lab 45 minutes), staff education, establishing a system to assure credibility of data, prospective data collection with real-time performance feedback, root-cause analysis of delayed cases, implementation and evaluation of improvement interventions, and ED nursing administrative support by holding staff accountable for performance. Intervals that measured ED performance were: ED arrival to first ECG, ECG to diagnosis, and diagnosis to lab. Total time to PCI (minutes) was measured from time of ED arrival to first balloon inflation. Results: Approximately 125 primary PCIs were performed annually. By the second year, ED performance improved from a mean of 103 to 47 minutes. Total time to PCI improved from a mean of 162 to 79 minutes. ED performance contributed significantly to the overall reduction in time to PCI as lab performance was consistently within 40 minutes. Improvements were sustained over time. Recommendations: Clinically significant improvement in performance was accomplished using a model that emphasized the role of nurse champions. Nurses selected for this role must have proven ability to: navigate the healthcare system, build trust across disciplines and departments, be innovative, maintain momentum for change, remain focused on the shared goal, and foster a blameless culture that is patient-centered with zero tolerance for missed opportunities to provide excellence in nursing care. This model may be replicated to other practice environments and disease conditions.
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.titleChanging Emergency Department Culture to Improve Care for Patients with STEMI: The Primary PCI Projecten_GB
dc.identifier.urihttp://hdl.handle.net/10755/163012-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Changing Emergency Department Culture to Improve Care for Patients with STEMI: The Primary PCI Project</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">2005</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Parkosewich, Janet, RN, MSN, CCRN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Yale-New Haven Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Cardiac Clinical Nurse Specialist</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">20 York Street, New Haven, CT, 06504, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(203) 688-2352</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">roberta.chuong@ynhh.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Bertie Chuong, RN, MS, CCRN; Margot Ververis, RN, MSN; Linda Konet, RN, MA; Jaime Gerber, MD; Harry Moscovitz, MD<br/></td></tr><tr><td colspan="2" class="item-abstract">Purpose: The American College of Cardiology and the American Heart Association (ACC/AHA) recommend treating ST-segment elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI) within 90 (30) minutes of emergency department (ED) arrival. To reduce treatment delays created by inefficient hospital systems, a performance improvement team was convened. The purpose of this study was to examine the effect that ED professional practice and system changes had on reducing time to primary PCI. Design: A descriptive study was conducted to determine adherence to the ACC/AHA standard and hospital performance measures (50 minutes ED door-to-lab time and 40 minutes lab-to-balloon time). Setting/Subjects: All patients admitted with STEMI from 12/98-12/03 to this emergency department, a Level I trauma center located in the Northeast, were included. Approval for conducting this study was obtained from this institution's human subjects research review committee. Methods: Five key success factors for accelerating improvement were applied including committed nurse-physician champions, shared goals, system solutions to eliminate barriers, credible and timely data feedback, and substantial administrative support. The ED nursing director and cardiac clinical nurse specialist, having expert knowledge and skill in practice and performance improvement served as clinical champions. Collaborating with physician champions, the ED culture transformed from one of inertia to urgency. Project interventions included: implementing the STEMI protocol with explicit goals from ED arrival (ECG 10 minutes, ED attending diagnosis 20 minutes, and patient transfer to lab 45 minutes), staff education, establishing a system to assure credibility of data, prospective data collection with real-time performance feedback, root-cause analysis of delayed cases, implementation and evaluation of improvement interventions, and ED nursing administrative support by holding staff accountable for performance. Intervals that measured ED performance were: ED arrival to first ECG, ECG to diagnosis, and diagnosis to lab. Total time to PCI (minutes) was measured from time of ED arrival to first balloon inflation. Results: Approximately 125 primary PCIs were performed annually. By the second year, ED performance improved from a mean of 103 to 47 minutes. Total time to PCI improved from a mean of 162 to 79 minutes. ED performance contributed significantly to the overall reduction in time to PCI as lab performance was consistently within 40 minutes. Improvements were sustained over time. Recommendations: Clinically significant improvement in performance was accomplished using a model that emphasized the role of nurse champions. Nurses selected for this role must have proven ability to: navigate the healthcare system, build trust across disciplines and departments, be innovative, maintain momentum for change, remain focused on the shared goal, and foster a blameless culture that is patient-centered with zero tolerance for missed opportunities to provide excellence in nursing care. This model may be replicated to other practice environments and disease conditions.</td></tr></table>en_GB
dc.date.available2011-10-27T10:38:01Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:38:01Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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