Interdisciplinary Collaboration to Decrease Door to Balloon Time in the STEMI Patient

2.50
Hdl Handle:
http://hdl.handle.net/10755/198363
Title:
Interdisciplinary Collaboration to Decrease Door to Balloon Time in the STEMI Patient
Abstract:
[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Interdisciplinary Collaboration to Decrease Door to Balloon Time in the STEMI Patient

Purpose: The purpose of an ST-Segment Elevated Myocardial Infarction (STEMI) evidence-based project (EBP) was to improve STEMI patient outcomes by decreasing door to balloon times for this patient population. Additionally, opportunities were identified to improve collaboration between Emergency Medical Services (EMS), the Cardiac Catheterization Lab (CCL), and the Emergency Department.

Design: This was an evidence-based project which arose from identification of a strategic objective to achieve chest pain accreditation. Quality data analysis identified opportunities to improve performance and patient outcomes.

Setting: A 316-bed community hospital; the equivalent of a Level II Emergency Department (ED).

Participants/Subjects: Patients of all ages who meet Center for Medicare/Medicaid Services (CMS) “STEMI" criteria.

Methods: A STEMI Committee was formed to improve care of patients who present to the ED. Its members include ED and CCL nurses, physicians, EMS Coordinator, a Pharmacist and other staff. The committee conducted a gap analysis in relation to the evidence-based American Heart Association Guidelines Door-to-Balloon (D2B) national standards and identified several opportunities. Members walked through the patient process, minute by minute, evaluating the triage process, electrocardiogram performance and interpretation, patient preparation, and transport to the CCL. A cardiologist provided classes to strengthen the skills of EMS and ED staff to identify a STEMI patient. A risk stratification form helps identify atypical presentations. Bedside creatinine and troponin levels are now being performed to ensure appropriate medication and contrast media dosing. Next, target goals were set. Interdisciplinary collaboration was a critical component of this process.

An electronic database was created into which all members could enter critical information. Timely feedback was then accomplished through STEMI e-mail alerts as well as through individual peer review to identify improvement opportunities. The STEMI Committee began to conduct case reviews every six weeks. The team cut minutes off their processes by packaging a STEMI medication kit, having technicians prep the patient’s groin in the ED, shortening the patient transport route to the CCL, and the ED nurse staying in the CCL to assist with patient preparation. Collaboration with a nearby hospital led to the purchase of 12-lead EKG machines for immediate EKG transmission by EMS. Goals were set for pre-hospital Code STEMI notification, a one-page call for all staff, resulting in earlier activation.

Results/Outcomes: Dramatic improvements have been made in the past few years. STEMI door to balloon time within 90 minutes was 73% in 2007 and 93% in 2010. STEMI mean door to balloon time decreased from 87 minutes in 2007 to 69 in 2010.

Implications: These outcomes are the result of a commitment to providing exceptional care of STEMI patients and a collaborative, interdisciplinary approach. Because “time is muscle”, critical analysis of all STEMI cases drives ongoing process improvements. We have improved relationships between EMS, ED staff and the CCL staff.

Successful strategies employed by this team included a “no blame” environment, identification of time wasters, innovation and collaboration and never losing focus on why this work is so important – our patients. And the beat goes on…

Repository Posting Date:
21-Dec-2011
Date of Publication:
21-Dec-2011

Full metadata record

DC FieldValue Language
dc.titleInterdisciplinary Collaboration to Decrease Door to Balloon Time in the STEMI Patienten_GB
dc.identifier.urihttp://hdl.handle.net/10755/198363-
dc.description.abstract[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Interdisciplinary Collaboration to Decrease Door to Balloon Time in the STEMI Patient<br/><br/>Purpose: The purpose of an ST-Segment Elevated Myocardial Infarction (STEMI) evidence-based project (EBP) was to improve STEMI patient outcomes by decreasing door to balloon times for this patient population. Additionally, opportunities were identified to improve collaboration between Emergency Medical Services (EMS), the Cardiac Catheterization Lab (CCL), and the Emergency Department. <br/><br/>Design: This was an evidence-based project which arose from identification of a strategic objective to achieve chest pain accreditation. Quality data analysis identified opportunities to improve performance and patient outcomes.<br/><br/>Setting: A 316-bed community hospital; the equivalent of a Level II Emergency Department (ED).<br/><br/>Participants/Subjects: Patients of all ages who meet Center for Medicare/Medicaid Services (CMS) “STEMI" criteria.<br/><br/>Methods: A STEMI Committee was formed to improve care of patients who present to the ED. Its members include ED and CCL nurses, physicians, EMS Coordinator, a Pharmacist and other staff. The committee conducted a gap analysis in relation to the evidence-based American Heart Association Guidelines Door-to-Balloon (D2B) national standards and identified several opportunities. Members walked through the patient process, minute by minute, evaluating the triage process, electrocardiogram performance and interpretation, patient preparation, and transport to the CCL. A cardiologist provided classes to strengthen the skills of EMS and ED staff to identify a STEMI patient. A risk stratification form helps identify atypical presentations. Bedside creatinine and troponin levels are now being performed to ensure appropriate medication and contrast media dosing. Next, target goals were set. Interdisciplinary collaboration was a critical component of this process. <br/><br/>An electronic database was created into which all members could enter critical information. Timely feedback was then accomplished through STEMI e-mail alerts as well as through individual peer review to identify improvement opportunities. The STEMI Committee began to conduct case reviews every six weeks. The team cut minutes off their processes by packaging a STEMI medication kit, having technicians prep the patient’s groin in the ED, shortening the patient transport route to the CCL, and the ED nurse staying in the CCL to assist with patient preparation. Collaboration with a nearby hospital led to the purchase of 12-lead EKG machines for immediate EKG transmission by EMS. Goals were set for pre-hospital Code STEMI notification, a one-page call for all staff, resulting in earlier activation.<br/><br/>Results/Outcomes: Dramatic improvements have been made in the past few years. STEMI door to balloon time within 90 minutes was 73% in 2007 and 93% in 2010. STEMI mean door to balloon time decreased from 87 minutes in 2007 to 69 in 2010. <br/><br/>Implications: These outcomes are the result of a commitment to providing exceptional care of STEMI patients and a collaborative, interdisciplinary approach. Because “time is muscle”, critical analysis of all STEMI cases drives ongoing process improvements. We have improved relationships between EMS, ED staff and the CCL staff. <br/><br/>Successful strategies employed by this team included a “no blame” environment, identification of time wasters, innovation and collaboration and never losing focus on why this work is so important – our patients. And the beat goes on… <br/><br/>en_GB
dc.date.available2011-12-21T12:47:34Z-
dc.date.issued2011-12-21T12:47:34Z-
dc.date.accessioned2011-12-21T12:47:34Z-
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